Background The well-being of patients with Parkinson’s disease may be improved by pharmaceutical care in community pharmacies. Objective To investigate the effects of standardised pharmaceutical care on health outcomes and quality of drug treatment in patients with Parkinson’s disease. Setting Community pharmacies in Germany. Method An open-label, multicentre, longitudinal, parallel-group study was conducted in outpatients with idiopathic Parkinson’s disease who were receiving anti-parkinsonian medication. Patients were recruited by 32 community pharmacists (pharmacy group) and local offices of the German Parkinson’s disease patients’ association (comparison group). All patients were assessed at baseline and at 8 months’ follow-up. In the intervening period, the pharmacists provided patients in the pharmacy group with standardised pharmaceutical care. Main outcome measure Mean change in symptom-related impairment of health status, assessed using the 23-item Parkinson’s Scale Total Score. Results In total 235 patients were enrolled into the study (113 pharmacy group; 122 comparison group). Between-group analysis showed that the mean changes in the primary and secondary endpoints, all 23-item Parkinson’s Scale sub-scores and the EuroQol 5-Dimension Questionnaire Index Score were significantly in favour of the pharmacy group after 8 months (p < 0.05 to p < 0.001), using a mixed model analysis. No significant changes were observed in prescribers’ guideline adherence, but there was a significant decrease in the proportion of patients receiving inappropriate drugs according to the Beers List in the pharmacy group (p < 0.01). Conclusion This study shows that significant benefits in patient health outcomes and age-related quality of drug treatment were gained when patients with Parkinson’s disease were provided with standardised pharmaceutical care in community pharmacies.

Impact of community pharmaceutical care on patient health and quality of drug treatment in Parkinson’s disease

Background Poor medication adherence in chronic illnesses such as Parkinson's disease (PD) is a significant but potentially addressable issue if core components are systematically measured. Objective To assess whether rating scales used in PD adequately cover essential components of medication adherence. Methods We accessed 5 databases targeting articles published before October 2019 and using rating scales to measure medication adherence in PD. The ABC Taxonomy from the European Ascertaining Barriers to Compliance Consortium and World Health Organization recommendations were used as the evaluation standard of 5 essential adherence dimensions (patient-based, health system-based, social-based, therapy-based, and health condition-based), 3 phases (initiation, implementation, and discontinuation), and 2 factors (intentional and nonintentional). Results We screened 192 and selected 16 studies, collectively using 5 medication adherence rating scales. No scale covered all essential components of medication adherence (dimensions, phases, factors). The Morisky Medication Adherence Scales were the most frequently used (11 studies), but they measure only 2 dimensions and phases. The Stendal Adherence to Medication Score (used in 1 study) measured all phases but only 2 dimensions, and the Brief Medication Questionnaire (used in 3 studies) measured 3 dimensions and 2 phases. Distinctions between intentional and nonintentional factors were not completely considered in any scale. Conclusions Although multiple studies target medication adherence in PD, the used scales did not measure all recommended components, highlighting the need to develop a sensitive, specific, and comprehensive tool for measuring medication adherence among patients with PD.

https://movementdisorders.onlinelibrary.wiley.com/doi/pdf/10.1002/mdc3.13006

Measuring Medication Adherence in Parkinson's Disease: A Systematic Review of Contributing Components in Rating Scales.

Content and impact of pharmacy services for patients with Parkinson's disease: A systematic review and meta-analysis

PURPOSE
Medication adherence is a multi-faceted construct associated with several positive consequences in people with chronic conditions. However, non-adherence currently represents a major issue in Parkinson's, potentially due to low perceptions of control. This study investigated the predictive ability of several aspects of perceived control on adherence in people with Parkinson's, while accounting for previously established predictors such as depression and medication variables.


MATERIALS AND METHODS
An online cross-sectional survey was carried out with 1210 adults with Parkinson's from 15 English-speaking countries. Demographic and clinical questions, as well as measures of depression, aspects of perceived control, and medication adherence were included. Pearson's correlations and a 4-block hierarchical regression analysis were performed to assess the relationship between the variables.


RESULTS
Perceived control explained a slightly higher amount of variance in medication adherence compared to medication variables when entered in the last block. Unexpectedly, depression was not significantly related with adherence. Internal locus of control was an independent negative predictor of adherence, while external dimensions of locus of control emerged as independent positive predictors.


CONCLUSIONS
In people with Parkinson's, perceptions of control may have a larger impact on adherence compared to medication variables. Implications for clinical practice and future research are discussed.Implications for RehabilitationPerceived control and depression are considered important constructs for medication adherence in Parkinson's, which in turn is often problematic for affected individuals.The specific predictive value of different aspects of perceived control on medication adherence in Parkinson's is currently unclear.This large-scale study found that perceptions of control may have a larger impact on adherence compared to medication variables, while depression was unrelated to it.A need for psychologically-informed interventions, person-centred approaches to medication management, and Parkinson-specific measures of adherence are highlighted.

Perceived control as a predictor of medication adherence in people with Parkinson's: a large-scale cross-sectional study.

Background Medication adherence is a crucial component in the management of patients with chronic diseases needing a long-term pharmacotherapy. Parkinson’s disease (PD) is a chronic, degenerative disease with complex drug treatment that poses challenging barriers to patient adherence. The adoption of best practices of scale development can contribute to generate solid concepts and, in the long run, a more stable knowledge base on the underlying constructs of medication adherence in PD measured by the items of the first scale to be created for this purpose. Purpose To present the development process and clinimetric testing plan of the Parkinson’s Disease Medication Adherence Scale (PD-MAS). Method We adopted a hybrid approach plan based on the United States Food and Drug Administration and Benson and Clark Guide that will create a patient-reported outcome instrument. We presented an overview of consecutive and interrelated steps, containing a concise description of each one. International research centers from Brazil and United States were initially involved in the planning and implementation of the methodological steps of this study. Results We developed a four-phase multimethod approach for the conceptualization and the clinimetric testing plan of the PD-MAS. First, we describe the development process of the conceptual framework of the PD-MAS underpinning the scale construct; second, we formalized the development process of the first version of the PD-MAS from the generation of item pools to the content validation and pre-testing; third, we established the steps for the first pilot testing and revision; fourth, we describe the steps plan for the first pilot testing and revision, to finally describe its clinimetric testing plan and validation. Conclusion The overview presentation of the development phases and the clinimetric testing plan of the PD-MAS demonstrate the feasibility of creating an instrument to measure the multidimensional and multifactorial components of the medication adherence process in people with PD.

/pdf/parkinsons-disease-medication-adherence-scale-24aox4dt.pdf

Parkinson’s Disease Medication Adherence Scale: Conceptualization, Scale Development, and Clinimetric Testing Plan

Results Statistically significant improvements were found in the proportion of people indicating satisfaction with information on what the medicine does and on possible impact on sex life. Furthermore a significant improvement was found on the “potential problems of medication” summary score on the SIMS. During the period of the study self reported physical function improved on the PDQ-39. No changes were found on the MARS.

A pilot evaluation of specialist community pharmacy services for patients with Parkinson's disease

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A pilot evaluation of specialist community pharmacy services for patients with Parkinson's disease