The Effect of a Structured Medication Review on Quality of Life in Parkinson’s Disease

Abstract

Background: Drug therapy is important for controlling symptoms in Parkinson’s disease (PD). However, it often results in complex medication regimens and could easily lead to drug related problems (DRP), suboptimal adherence and reduced treatment efficacy. A structured medication review (SMR) could address these issues and optimize therapy, although little is known about clinical effects in PD patients. Objective: To analyze whether an SMR improves quality of life (QoL) in PD. Methods: In this multicenter randomized controlled trial, half of the 202 PD patients with polypharmacy received a community pharmacist-led SMR. The control group received usual care. Assessments at baseline, and after three and six months comprised six validated questionnaires. Primary outcome was PD specific QoL [(PDQ-39; range 0 (best QoL) – 100 (worst QoL)]. Secondary outcomes were disability score, non-motor symptoms, general health status, and personal care giver’s QoL. Furthermore, DRPs, proposed interventions, and implemented modifications in medication schedules were analyzed. Results: No improvement in QoL was seen six months after an SMR, with a non-significant treatment effect difference of 2.09 (–0.63;4.80) in favor of the control group. No differences were found in secondary outcomes. In total, 260 potential DRPs were identified (2.6 (±1.8) per patient), of which 62% led to drug therapy optimization. Conclusion: In the current setting, a community pharmacist-led SMR did not improve QoL in PD patients, nor improved other pre-specified outcomes.

Structured medication reviews in Parkinson’s disease: pharmacists’ views, experiences and needs – a qualitative study

“…However, in our analysis regarding proposed drug interventions, classified by 12 drug classes, 19% concerned anti-dopaminergic drugs, which was thereby the biggest category. 12 This different finding might be explained by the fact that the pharmacist was possibly more than usually focused on PD drugs since PD patients were the target of our study. It is, however, not per se a problem when the pharmacist prefers not to change the medical specialist’s prescriptions: the pharmacist takes into consideration the entire spectrum of used drugs, including practical aspects regarding drug intake.…”

“… 30 Although withdrawal rates in our previous study were lower, there were also PD patients who did not receive an SMR despite commitment of the involved pharmacist. 12 …”

“… 19 In our quantitative Medication Review in PD study, executed in accordance with the Dutch Medication Review guidelines at that time, we found no improvement in quality of life in PD patients after an SMR and higher expenditure of health care costs compared to usual care. 9 , 12 , 33 The explanation for these outcomes seems multifactorial. The merely mild disease severity, the primary care setting, the difficult multidisciplinary communication lines, patient characteristics or any combination might play a role.…”

“…Participating pharmacists all contributed to the Medication Review in Parkinson study. 12 A purposive sampling method was used for participant selection with a range of working experience and different pharmacy chain stores. In order to be eligible, participants had to have executed at least one SMR in the study.…”

“…Our recent study, focusing on the effect of a community pharmacist-led SMR on quality of life in patients with PD, demonstrated that the execution of an SMR appeared challenging in some patients. 11 , 12 In this multicentre randomized controlled trial, half of 202 PD patients with polypharmacy received an SMR, while the other half received usual care. Although the process of patient selection was already accomplished and pharmacists had followed training regarding PD, some of the PD patients in the SMR group did not receive an SMR eventually, and reasons for cancelling were not always known.…”