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The effect of a structured medication review on quality of life in patients with Parkinson's Disease

Kocabiyik, T. and Ocal, G. (2016) The effect of a structured medication review on quality of life in patients with Parkinson's Disease.

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Abstract:Background: Parkinson's Disease (PD) is a neurodegenerative movement disorder that often appears after the age of 50. The characteristic motor impairments of PD result from degenerative loss of midbrain dopamine neurons in the substantia nigra. The treatment of Parkinson’s Disease is symptomatic with a large number of drugs several times a day. This causes complex medication schedules (complex polypharmacy) by patients with PD. Complex polypharmacy has a negative influence on medication adherence. Medication non-adherence has physical consequences (increased symptoms) and financial consequences (increased healthcare costs). A medication review is a way to simplify complex polypharmacy possibly resulting in an increase of medication adherence which can lead to positive effects on the symptoms of patients. This eventually can increase the Quality of Life (QoL) in PD patients. Objectives: The main goal of this study is to analyze the effects of a structured medication review on QoL in patients with PD living in the region Twente, The Netherlands. Secondary objectives are the presence of non-motor symptoms, experience of own health status and disease related QoL in patients with PD. Method: This study is designed as a randomized controlled multicenter trial in two regional hospitals. Patients in the intervention group receive a structured medication review, while the patients in the control group do not receive the intervention but only usual care. The study is conducted in the hospitals MST and ZGT. Patients with an age ≥ 18, who express motor and non-motor symptoms due to the disease, with ≥4 different medications daily at ≥4 different intake moments and living (semi)independent, were included. The intervention consisted of a medication review performed by a community pharmacist. With a follow up of three and six months. Outcomes were the scores of PDQ- 39 which measures QoL in patients with PD, NMS-Quest which measures presence of Non-Motor Symptoms in patients with PD, EQ5D which measures Disease Related QoL and VAS which measures experience of own health. Results: In total 105 patients were included with a mean age of 70.5 years for the intervention group and 72.3 years for the control group. After the intervention, the amount of medication per day in the intervention group decrease with 0.23 (CI-95% [0.01;0.47]). The intake moments per day increased after the intervention with 0.03 (CI-95% [-0.20;0.14].The intervention group rated the PDQ-39 on average 0.9 higher than the control group after 6 months (CI-95%[-6.4;8.2]), the EQ-5D -0.001 lower(CI-95%[-0.09;0.09]), and the NMS-Quest 2.0 higher(CI-95%[-0.3;4.4]), which are equal to a decrease in QoL. But they rated the VAS 3.4 higher than the control group(CI-95%[-4.2;11.1]), which means an increase in QoL. But the primary and secondary outcomes did not change significantly between the intervention group and the control group. The subgroup analyses showed that the women, patients with H&Y ≥ 3 and patients with age ≥70 rated their QoL lower compared to men, patients with H&Y<3 and patients with age < 70. But there was no significant difference between the intervention and control group in the subgroups gender, age, and H&Y. Conclusion: The results of the primary and secondary outcomes were not as expected. The Quality of Life in patients with PD did not improve after a medication review. Due to the non-significant results and a small study population, a powerful and reliable conclusion cannot be taken.
Item Type:Essay (Bachelor)
Clients:
MST, Enschede, Nederland
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Health Sciences BSc (56553)
Link to this item:http://purl.utwente.nl/essays/70315
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