Dynamics of Parkinson’s Disease Multimodal Complex Treatment in Germany from 2010–2016: Patient Characteristics, Access to Treatment, and Formation of Regional Centers

Abstract

Parkinson’s disease (PD) is currently the world’s fastest-growing neurological disorder. It is characterized by motor and non-motor symptoms which progressively lead to significant clinical impairment, causing a high burden of disease. In addition to pharmacological therapies, various non-pharmacological treatment options are available. A well established and frequently used multiprofessional inpatient treatment concept in Germany is “Parkinson’s disease multimodal complex treatment” (PD-MCT) which involves physiotherapists, occupational therapists, speech therapists, and other specializations for the optimization of treatment in PD (ICD G20) and other Parkinsonian syndromes (ICD G21 and G23). In this study we analyze the PD-MCT characteristics of 55,141 PD inpatients who have been integrated into this therapy concept in Germany in the years 2010–2016. We demonstrate that PD-MCT is increasingly applied over this time period. Predominately, PD patients with advanced disease stage and motor fluctuations in age groups between 45 and 69 years were hospitalized. In terms of gender, more male than female patients were treated. PD-MCT is provided primarily in specialized hospitals with high patient numbers but a minor part of all therapies is performed in a rather large number of hospitals with each one treating only a few patients. Access to PD-MCT differs widely across regions, leading to significant migration of patients from underserved areas to PD-MCT centers – a development that should be considered when implementing such therapies in other countries. Furthermore, our data imply that despite the overall increase in PD-MCT treatments during the observational period, the restricted treatment accessibility may not adequately satisfy current patient´s need.

Self-Reported Nonadherence Predicts Changes of Medication after Discharge from Hospital in People with Parkinson’s Disease

“…For inpatient treatment, however, this also means that it does not make sense to increase dosages immediately before discharge because side effects would then occur with a delay at home. Unfortunately, this is exactly what is demanded by health insurance companies and the medical service of the health insurance companies in Germany, namely, the change in medication until the day of discharge, so that the treatment in the PD multimodal complex programme [ 23 ] can be fully billed. The second aspect, the extent to which nonadherent patients are more likely to perceive side effects (or whether side effects due to inadequate medication are more frequent) would have to be examined in further confirmatory studies with larger numbers of cases.…”

Parkinson’s Disease in Women and Men: What’s the Difference?

“…A retrospective observational study looking at Medicare data-a government-financed health insurance program for the elderly and disabled in the United Stateshighlighted that women are less likely to have specialist (neurologist) care, together with nonwhites [8]. Accordingly, an a posteriori analysis of multiprofessional treatment approach PD-MCT (i.e., "Parkinson's disease multimodal complex treatment") conducted in Germany in the years 2010-2016 and involving pharmacological and nonpharmacological treatment options such a physical therapy, occupational therapy, and speech therapy, revealed that more male than female patients were treated under this program [9]. A recent study covering 7209 patients at 21 centers in the United States, Canada, the Netherlands, and Israel, disclosed that women are also less likely than men to have informal caregiver support (i.e., support from spouse, family or friends).…”

Parkinson Network Eastern Saxony (PANOS): Reaching Consensus for a Regional Intersectoral Integrated Care Concept for Patients with Parkinson’s Disease in the Region of Eastern Saxony, Germany

“…From a patient's perspective, PANOS strives to address core requirements: according to a Dutch study carried out in compliance with the voice of customer (VoC) approach [17], the following are the most important patient requirements: (1) desire for self-management, (2) better collaboration between healthcare providers, (3) more time for discussing the future, (4) one healthcare provider who can act as a personal case manager, (5) more knowledge of the disease, (6) more support from my pharmacist, (7) increased focus on the needs of my spouse, (8) more contact with other patients, (9) more provision of information and (10) less fragmentation of healthcare. PANOS addresses aspects 1, 3, 5, 8 and 9 by incorporating a structured patient education program according to the self-management concept, aspects 2 and 10 by the establishment of a structured care pathway and aspect 4 by the provision of such a personal case manager.…”

“…PD care in Germany involves a large number of different healthcare providers and is hindered by fragmentation, lack of communication and coordination [6]. Although defined as a standard of care, the access to specialized treatment is highly limited, aggravating imbalances in care access and hampering the efficient delivery of individualized, multiprofessional care [7].…”