Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA.
University of Lund, Lund, Sweden.
Parkinsonism Relat Disord. 2023 Nov;116:105514. doi: 10.1016/j.parkreldis.2023.105514. Epub 2023 Jul 6.
Device-aided therapy may improve the quality of life (QoL) for people with advanced Parkinson's disease (PD) and poorly controlled symptoms with oral therapy. MANAGE-PD is a validated tool classifying patients based on symptom control and advanced treatment eligibility. This study focused on patient/caregiver reported outcomes and healthcare resource utilization among patients grouped by MANAGE-PD categories.
Device-aided therapy-naïve patients receiving oral treatments were identified from the Adelphi Parkinson's Disease Programme. Patients were categorized (category 1 to 3) using MANAGE-PD. PD-specific QoL (PDQ-39), care partner burden (ZBI), satisfaction with current treatment, healthcare resource utilization, associated healthcare costs, and future treatment discussion with providers were measured. Categories were compared using ANOVA, t-test, chi square and adjusted regression analyses.
Of the analytical sample (n = 2709), 18.9% were inadequately controlled on current therapy and potentially eligible for device-aided therapies (category 3). As expected, they had worse patient/caregiver reported outcomes versus patients in categories 1 or 2. However, the degree of difference in healthcare resource utilization, including: greater number of hospitalizations, emergency room (ER) visits and consultations, higher likelihood of being recipients of respite care, and greater PD treatment burden, was unexpected. Importantly, of patients in category 3 and their care partners, >40% did not report discussions with providers about device-aided therapies.
MANAGE-PD category 3 patients had significantly higher burden on healthcare resources versus patients well-controlled with oral treatment or requiring only oral medication adjustments; yet almost half had no discussion on device-aided therapies with providers. Device-aided therapies may be considered in these patients.
辅助设备治疗可能会提高晚期帕金森病（PD）患者和口服治疗控制不佳的患者的生活质量（QoL）。MANAGE-PD 是一种经过验证的工具，可根据症状控制和高级治疗资格对患者进行分类。本研究重点关注了根据 MANAGE-PD 类别分组的患者的患者/护理人员报告的结果和医疗资源利用情况。
从 Adelphi Parkinson's Disease 计划中确定了接受口服治疗的辅助设备治疗初治患者。使用 MANAGE-PD 对患者进行分类（类别 1 至 3）。测量了 PD 特异性生活质量（PDQ-39）、护理人员负担（ZBI）、对当前治疗的满意度、医疗资源利用情况、相关医疗费用以及与提供者进行的未来治疗讨论。使用 ANOVA、t 检验、卡方检验和调整后的回归分析比较了类别。
在分析样本（n=2709）中，18.9%的患者当前治疗效果不理想，可能适合辅助设备治疗（类别 3）。正如预期的那样，他们的患者/护理人员报告的结果比类别 1 或 2 的患者更差。然而，医疗资源利用的差异程度，包括：更多的住院治疗、急诊室（ER）就诊和咨询、接受临时护理的可能性更高，以及 PD 治疗负担更大，这是出乎意料的。重要的是，在类别 3 的患者及其护理人员中，超过 40%的人没有与提供者讨论辅助设备治疗。
与口服治疗控制良好或仅需要调整口服药物的患者相比，MANAGE-PD 类别 3 的患者对医疗资源的负担明显更大；然而，近一半的患者与提供者没有讨论过辅助设备治疗。在这些患者中可以考虑使用辅助设备治疗。
