Parkinsons Disease (PD) is a condition where the movement controlling function of the brain is impaired. This leads to movements occurring at rest, such as tremors, twitching, and pill rolling hand movements. Eventually, general coordination is affected, with affected individuals having a slower, shuffling walk, easy loss of balance, and loss of accuracy needed for finer movements.
In countries with an aging population like the UK, there has been a rise in the cases of PD. While PD is currently incurable, there are quite a few medications that can be used to treat this condition. Additionally, while the condition is initially diagnosed and treated by a neurologist and will thus involve secondary specialist support and guidance, there is an increased burden of general practitioners (GPs) to continue care for PD patients. As there are quite a few options in medications, following guidelines for the treatment of PD can be taxing, because new medications may have come out, and because these guidelines may have changed and evolved. Given the multiple conditions that GPs have to treat, it is important to understand whether or not GPs follow these guidelines.
This study aims to describe how GPs prescribe treatments for PD. We aim to map out the treatment pathway of patients based on which medications they receive and the order in which they receive those medications.
With the treatment pathway mapped out, interventions to improve the application of guidelines can be deployed to aid GPs in treating PD, potentially leading to better controlled disease among affected patients.
PD is a movement disorder marked by the loss of dopaminergic neurons. These neurons mediate movement and contribute to coordination, balance, and fine motor control. The loss of these neurons cause patients to lose such functions, leading to increased falls, tremors at rest, automatic coordination, and even speech and writing issues. The result is a significant impairment in activities of daily living and occupation, and decreased quality of life.
PD tends to appear in the older age group, when the progressive loss of dopaminergic neurons manifests symptoms. Thus, in countries with aging populations such as the UK, there is an increased prevalence of PD. The management of PD is complex and requires navigating through the different medication options available. While speciality care is needed in the diagnosis and initial management of PD patients, including shepherding patients through medication regimens, shifting them and adjusting doses in order to achieve the best possible control of symptoms while avoiding side effects, GPs have been given the responsibility to continue care for PD patients in primary care. As with many conditions, the guidelines for PD are complex and frequently updated, leaving GPs with the burden of updating themselves whenever the newest principles of management are changed.
This study aims to map the treatment pathway of patients in primary care based on the medications prescribed to them by GPs. We will be using a retrospective descriptive single cohort study design implemented on a clinical dataset for primary care from CPRD. The primary outcome of this study would be a distribution of patients across different treatments used in each line of therapy for PD. No comparisons will be made. Patient counts and percentages shall be reported.
With this study, we will be able to verify compliance with clinical practice guidelines, and employ interventions in primary care to address shortfalls in the treatment pathway.
Demographic characteristics (age, sex, total time in cohort, total follow-up time); treatment pathway (number of lines of therapy, number patients reaching each line of therapy, number of patients in each regimen within each line of therapy); prescription length (time from start to end of prescription)
Adrian Paul J. Rabe - Chief Investigator - Health iQ Ltd ( UK ) t/a CorEvitas
Adrian Paul J. Rabe - Corresponding Applicant - Health iQ Ltd ( UK ) t/a CorEvitas
Gulsah Akin Unal - Collaborator - Health iQ Ltd ( UK ) t/a CorEvitas
Gulum Alamgir - Collaborator - Health iQ Ltd ( UK ) t/a CorEvitas
James Tilbury - Collaborator - Health iQ Ltd ( UK ) t/a CorEvitas
Jay Were - Collaborator - Health iQ Ltd ( UK ) t/a CorEvitas
Gulsah Akin Unal - Collaborator - Health iQ Ltd ( UK ) t/a CorEvitas
ONS Death Registration Data;Practice Level Index of Multiple Deprivation