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Disease Complications and Healthcare Use More Common in Women Than Men, Dutch Study Finds

gender differences

Women with Parkinson’s are more likely than men to have disease-related complications within five years of diagnosis and more likely to access healthcare services sooner, findings from a Dutch study suggest.

The study, “Sex-Specific Patient Journeys in Early Parkinson’s Disease in the Netherlands,” was published in Frontiers in Neurology.

Throughout their disease’s course, Parkinson’s patients need to rely on various healthcare providers, from general practitioners to therapists and neurologists, to maintain a quality of life.

“This ‘journey through the healthcare system’ varies per individual because of heterogeneity of symptoms, differences in disease progression rate, and the occurrence of PD-related complications. One important source of this variation might be sex differences in the presentation of PD [Parkinson’s disease],” the researchers wrote.

Evidence indicates that Parkinson’s affects more men than women, and that the disease starts at earlier ages and progresses faster in men. Women are known to have more tremor-dominant Parkinson’s, while men most often experience the akinetic-rigid kind — that typified by a slowness of movement, accompanied by muscle stiffness, postural instability and gait difficulties.

Nonetheless, it remains to be understood if these sex differences translate into “patient journeys” distinct to Parkinson’s. Knowing these journeys can help to improve access to services, and enhance coordination and quality of care.

Medical data today are routinely collected and stored in administrative healthcare databases, and typically cover both a patient’s health status and healthcare-related services. Such information can be found through electronic health records, medical claims, and drug and disease registries.

Investigators at Radboud University Medical Center used national medical claims data to reconstruct the sex-specific journey of Dutch Parkinson’s patients over the first five years after a diagnosis. (The study notes that the Netherland has “compulsory health insurance … [and] comparatively low out-of-pocket payments.”)

The claims database chosen for analysis contained data of all people diagnosed with Parkinson’s disease between 2012 and 2016 in the Netherlands. Researchers analyzed the time it took for patients to receive care from neurologists, allied healthcare therapists, or primary care physicians. They also studied the occurrence of Parkinson’s-related hospitalizations, incidences of pneumonia, orthopedic injuries, enrollment in a nursing home, and death.

In total, 22,293 medical claims regarding early Parkinson’s were analyzed: 13,518 (60.6%) involving male patients and 8,775 (39.4%) for females. At the time of diagnosis, men had a mean age of 71.6 years, and women 72.5.

The first Parkinson’s-related complications, such as pneumonia, orthopedic injuries, and hospitalization, began to be reported at a median of 1.8 years for women and 2.3 years for men.

Five years post-diagnosis, 68.7% of the men had at least one Parkinson’s disease-related complication, 22.5% lived in a nursing home, and 18.3% had died. Among the women, a greater percentage had at least one Parkinson’s complication ( 73%) and lived in a nursing home (27.2%), but a lesser percentage (14.6%) had died.

Female patients were more likely to visit their general practitioners earlier and more often than did male patients, starting about one month after diagnosis. Women began to doctor visits 31 days post-diagnosis and returned for checks-ups ever six weeks, men made a first visit at 41 days post-diagnosis and returned every eight to nine weeks.

Women also started their physiotherapy treatment earlier and returned more often: five months after diagnosis and once every five to six weeks thereafter; among men, physiotherapy started at eight months and continued once every seven to eight weeks.

“After 5 years, 37.9% … of women had visited an occupational therapist and 18.5% … a speech and language therapist at least once,” compared to 33.1% and 23.7%, respectively, for men, the researchers wrote. These differences were statistically significant.

Overall, gender differences among Parkinson’s patients were found to be related not only disease manifestations or progression, but also with the use of healthcare services.

“[O]ur findings suggest that women experience complications and access most healthcare services sooner after diagnosis and more frequently than men,” the researchers wrote.

“We hope these insights can lead to better and more personalized care for [Parkinson’s disease] patients of both sexes,” they concluded.

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New €10M Study Looks to Improve Integrated Care for Parkinson’s Patients in the UK and Netherlands

Neupro, UCB, China

The University of Bristol in England is leading a five-year, €10 million study aimed at finding ways to better integrate care for Parkinson’s disease patients while lowering costs, the institution recently announced. 

Over the course of the trial, the new care model is expected to be delivered to about 1,000 Parkinson’s patients in areas served by the Royal United Hospitals in Bath, England. At the same time, similar healthcare innovations will be implemented in Nijmegen, Netherlands.

Titled Proactive and Integrated Management and Empowerment in Parkinson’s Disease (PRIME-PD), the trial will be led by Emily Henderson, MD, geriatrician at the Royal United Hospital and an honorary senior lecturer at the University of Bristol. 

Project partners include The Gatsby Foundation and Radboud University Medical Center in Nijmegen, Netherlands.

“The robust design and evaluation of this new conceptual model will ensure that any positive findings can be widely implemented to ensure that people living with the condition can benefit,” Henderson said.

Project methodology and evaluation will be led by the university’s Bristol Randomised Trials Collaboration (BRTC) and Yoav Ben-Shalom, PhD, professor of clinical epidemiology.

BRTC designs and conducts randomized, controlled trials in patient care settings, as well as in schools and public health fields. It also conducts complex trials and feasibility studies that include methodological research, and provides collaboration and advice for researchers looking to develop and initiate new trials.

While a variety of healthcare providers typically support each Parkinson’s patient, according to the press release, collaboration can be inconsistent. As a result, patients may not get the right services at the right time to deal with disease symptoms.

By way of remedy, the project will craft and test a new model of proactive and cohesive care that hopes to better meet patients’ needs. It will be evaluated both for its ability to improve patient care and cost-effectiveness.

The model will build on the experience and infrastructure already in existence in the United Kingdom and the Netherlands.

 “The only way to overcome the current impasse in healthcare is to have two critical components at your disposal: firstly, adequate funding to cover the gap between the ideal model of care and what is currently reimbursed by national healthcare systems or insurers; and secondly, sufficient amount of time to scientifically demonstrate that the new concept works, as reflected by an improved quality of life for patients as well as cost savings for society,” said Bas Bloem, MD, PhD, professor of movement disorders in the neurology department of Radboud University.

With support from the National Institute for Health Research Clinical Trials Units Support Funding, the BRTC works with clinicians and researchers across the UK. Those interested in working with them may go here for information.

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Source: Parkinson's News Today