Do neurologists in Germany adhere to the national Parkinson's disease guideline?

Abstract

Implementation of guidelines can improve clinical practice. The aim in this study was to investigate whether neurologists in Germany adhered to the national Parkinson’s disease guideline. Data were obtained from a cross-sectional survey of 60 neurologists. Analyses were performed on 320 patients with idiopathic Parkinson’s disease with either low grades of functional impairment (Hoehn and Yahr stage I) or higher grades of functional impairment (stage II–V) but without motor complications. The sample was divided into four groups depending on age and grade of functional impairment. For each group, a biometric parameter on the use of dopamine agonists and L-dopa was defined based on the guideline. In patients aged <70 years, the recommendation to use dopamine agonists without L-dopa (parameter 1) was observed in 53% of patients with lower grades of functional impairment, whilst recommended use of dopamine agonists in more functionally impaired patients (parameter 2) was followed to a greater extent (84%). In patients aged ≥70 years, recommendations to use L-dopa without dopamine agonists were adhered to in only 50% of less functionally impaired (parameter 3) and 52% of more functionally impaired (parameter 4) patients. In conclusion, our results indicated there was moderate but not full adherence to the guideline.

Adherence to treatment guideline recommendations for Parkinson’s disease in Japan: A longitudinal analysis of a nationwide medical claims database between 2008 and 2016

“…Furthermore, long-term treatment with more costly DAs might be a factor worthy of consideration in these patients with longer life expectancy than older patients. A similar trend in L-dopa use was observed in studies in Taiwan and Germany [12,25]. This observation reflects the advantages of monotherapy with L-dopa compared with other anti-PD drugs in terms of cost-effectiveness and the ability to add an adjunct therapy when PD progresses [26].…”

Patterns and Determinants of Prescribing for Parkinson’s Disease: A Systematic Literature Review

“…Of the 44 studies, 35 were designed to examine the prescribing pattern of PD medications with or without measuring prescribing determinants (Table 1) [41–48, 50, 51, 53–75, 83, 84] and 9 studies measured the prescribing determinants and utilisation factors without measuring prescription rates of PD medications (Table 2) [49, 52, 76–82]. The sources of data varied according to each study design; insurance-claims, prescription registries, or drug sales databases in 16 studies [45–47, 53, 54, 56–58, 61, 62, 64, 65, 72, 75, 81, 83]; medical charts and administrative databases in 13 studies [41–43, 48, 50, 51, 66–70, 79, 82]; patients' interviews, questionnaires, or surveys in 12 studies [44, 55, 59, 60, 63, 71, 73, 74, 76–78, 84]; and finally, 3 studies were designed as post hoc studies that used previously conducted clinical trials to find the prescribing patterns and determinates of PD medications (see Tables 1 and 2) [49, 52, 80]. The timeframe of the studies that were reviewed was from 1986 to 2017.…”

“…The timeframe of the studies that were reviewed was from 1986 to 2017. Out of the studies that examined prescribing patterns, 19 were cross sectional in design and calculated the prescription rates of PD medications in a particular period without comparing the rates with other periods [41–45, 48, 50, 55, 57, 60, 64, 68, 69, 71, 73–75, 83, 84] and 15 were designed to compare the prescribing patterns in two or more different periods [46, 47, 51, 53, 54, 56, 58, 59, 61–63, 65–67, 72]. In one study that was conducted in Singapore, the year of the study was not possible to establish [70].…”

<p>Therapeutic strategies in the early stages of Parkinson&rsquo;s disease: a cross-sectional evaluation of 15&nbsp;years&rsquo; experience with a large cohort of Romanian patients</p>

“…The decision of a clinician to choose LD or DA as an introductory therapy is influenced by a number of factors but a more detailed analysis of this decision (including, but not limited to, the advantages and disadvantages as well as the short and long-term side effects of individual DAs) goes beyond the scope of this study. LD therapy is limited by the appearance of motor complications, which in turn may lead to an unjustified phobia regarding LD and the overuse of DAs, whereas the use of DAs is complicated mainly by the non-motor complications, such as impulse control disorders, daytime sleepiness and sudden sleep 36–42. Because our study looks at a long period it is hard to retroactively statistically assess how much of the clinical decisions was influenced by the early optimism (as reflected in the initial studies) regarding the potential disease-modifying effect as well as the magnitude of the clinical efficacy of DAs.…”