They can assess adherence, identify drug-related problems, follow pharmacotherapy and provide education.
Each year, approximately 60,000 people are diagnosed with Parkinson’s disease (PD), a progressive nervous system disorder that affects movement. By 2030, approximately 1.2 million people in the United States will be living with PD.1
The right choice of therapy can be challenging, as it is typically based on several factors, including age of onset and stage of the disease.2 In addition, patients with PD usually have co-morbidities that require medication, which can lead to polypharmacy and drug interactions.
The D-PRESCRIBE randomized clinical trial (NCT02053194) demonstrated the importance of having a pharmacist on board. Findings showed that, compared with usual care, pharmacist-led educational intervention for adults 65 years of age or older resulted in greater discontinuation of inappropriate medication prescribing at 6 months: 106 of 248 patients (43%) in the pharmacist-led intervention group no longer filled prescriptions for inappropriate drugs versus 29 of 241 (12%) in the control group.3
By providing medication therapy management (MTM) services that assess adherence, identify drug-related problems, monitor pharmacotherapy and provide education (Figure), pharmacists can play an important role in the multidisciplinary care of patients with PD (Figure).2-4
A prospective study evaluated the involvement of a clinical pharmacy specialist (CPS) in the neurology outpatient clinic at West Palm Beach Veterans Affairs Medical Center in Florida. Patients with both PD and a psychiatric diagnosis who received at least 1 psychotropic drug were eligible to participate in the MTM telephone consultation. During these interviews, patients were evaluated for neuropsychiatric symptoms, and the CPS ordered and monitored lab work, provided patient education and primary care, and adjusted medication. The CPS also personally offered medication education for 24 patients with PD and their caregivers, and all participants reported that these were beneficial. During 4 (25%) of the consultations, pillboxes were ordered to aid adherence, and 49 non-pharmacological and pharmacological interventions were performed for 10 patients during the study period. The neurology telephone clinic turned out to be a success.4
One meta-analysis evaluated 19 studies involving a total of 1458 patients with PD from 9 countries to investigate the role of pharmacists and the impact of their interventions. Studies with randomized controlled trials or observational designs reporting on pharmacy services for patients with PD were included in the analysis. Most pharmacy services were provided in outpatient clinics. Some were offered in inpatient and outpatient clinical practices. Research results showed that drug side effects were the most commonly reported drug-related problem. The following were the most common pharmacist interventions for patients with PD2:
- Evaluating adherence: 12 studies
- Assessment of Adverse Reactions: 12 Studies
- Medication Review: 12 Studies
- Identifying Drug Interactions: 11 Studies
- Identifying Inappropriate Drug Therapy: 11 Studies
- Monitoring pharmacotherapy: 11 studies
- Educating the patient: 10 studies
About the author
Jennifer Gershman, PharmD, CPh, PACS, is a Pharmacist for Drug Information and Pharmacy Times® employee living in South Florida.
1. Statistics. Parkinson’s Foundation. Accessed May 4, 2022. https://www.parkinson.org/Understanding-Parkinsons/Statistics
2. Yi ZM, Li TT, Tang QY, Zhang Y, Willis S, Zhai SD. Content and impact of pharmacy services for patients with Parkinson’s disease: a systematic review and meta-analysis. Medicine (Baltimore). 2020; 99(27):e20758. doi:10.1097/MD.000000000020758
3. Martin P, Tamblyn R, Benedetti A, Ahmed S, Tannenbaum C. Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults: the D-PRESCRIBE randomized clinical trial. JAMA. 2018;320(18):1889-1898. doi:10.1001/jama.2018.16131
4. Stefan TC, Elharar N, Garcia G. Implementation and evaluation of Parkinson’s disease management in an outpatient pharmacy-administered neurologic telephone clinic. Mental Health Clinic. 2018;8(3):159-162. doi:10.9740/mhc.2018.05.159