You can find out more about NPF's National Medical Director, Dr. Michael S. Okun, by also visiting the NPF Center of Excellence, University of Florida Center for Movement Disorders & Neurorestoration.
In the May issue of Neurology, Dorsey and colleagues from the National Parkinson Foundation Center of Excellence in Rochester, NY, asked an interesting question: can group visits for Parkinson’s disease (PD) care provide a feasible alternative to regular doctor visits? The idea of group visits is not new for other chronic diseases, but had not been previously studied in PD. Dorsey and colleagues randomly divided patients into two groups: the first would have 12 months of group visits and the second would continue regular “one on one” style care. Four group visits were administered over the course of a year, with each lasting an hour-and-a-half. Because of the small size of the study, the investigators were primarily interested in whether the care model for PD was feasible (could they recruit and would the patients complete the study). The investigators were also interested in whether there would be an added benefit in quality of life measures.
Ultimately, 30 patients and 27 caregivers participated. Quality of life was not discovered to be different between the groups randomized to group versus one on one care. The investigators concluded that group care was feasible, but that it did not offer any enhancement to quality of life. There were many weaknesses in the study. The readers were not told how many people had to be screened to ultimately reach the goal of 30 patients. It would have been useful to know who declined participation, as this information may have enhanced the understanding of who will be the captive audience for the future of PD care groups. We would suspect that patients with shorter disease durations and those with less severe disease would potentially opt for group care, but this data remains unknown. Also, more patients will need to be included in the future, and more documentation provided on the economic and non-economic benefits to the health care system.
There is something very attractive about group visits for many PD patients. First, they receive a solid hour and a half with the physician. Next, they get a rare opportunity at 40 minutes of education on a PD topic of the group’s choice. Finally, patients and caregivers get 20 minutes of discussion and questions, followed by the option of a quick 10 minute personal visit with the doctor. The group visit therefore offers opportunities for socializing, and for fostering the idea that one is not alone with their PD.
Despite the potential benefits of group visits, many patients who travel to see their PD doctor may have serious motor, non-motor and quality of life issues. Many patient problems could be private, and may be most appropriately addressed behind closed doors. Patients may need more than 10 minutes to review medications and to update prescriptions. Group visits may struggle in addressing the need for interdisciplinary services such as physical therapy, occupational therapy, speech therapy, and social work.
What shape will the future of group care visits for PD take over the next two decades? Group visits may be better suited to different arenas such as exercise therapy, dance therapy and psychological counseling—and these arenas may provide an easier argument for insurance-based reimbursement. Group visits may have a future in helping select patients and families with their PD issues; however, which types of patients and services should be thoughtfully addressed. Finally, it will be important to better define the economic and non-economic benefits to the health care system of a group approach—it is definitely feasible, but as a society we should ask when and where it will have its greatest impact.
Dorsey ER, Deuel LM, Beck CA, Gardiner IF, Scoglio NJ, Scott JC, Marshall FJ, Biglan KM. Group patient visits for Parkinson disease: A randomized feasibility trial. Neurology. 2011 May 3;76(18):1542-7. Epub 2011 Apr 27. PubMed PMID: 21525426.
Posted: 6/1/2011 7:05:39 AM by
Browse current and archived What's Hot in PD? articles, the National Parkinson Foundation's monthly blog for people with Parkinson's written by our National Medical Director, Dr. Michael S. Okun.
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Neurologist Care Reduces Hospitalizations in Parkinson's Disease
A Victory in Court for Parkinson's Disease Patients who Require Ongoing Rehabilitative Therapies
Given the recent FDA announcement about Mirapex (pramipexole), should I be worried about dopamine agonists?
What about the new Parkinson’s Disease Vaccine? What should I know?
Caffeine as a Potential Treatment for Parkinson’s Disease
Time to Consider GPi DBS for Parkinson’s Disease: A Shift in the Practice of Patient Selection for DBS
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Placing Stem Cells in Animal Models of Parkinson’s Disease: Another Important Step
Important News for the Parkinson’s Disease Community: More Evidence that Sinemet and Madopar are Not Toxic and do Not Accelerate Disease Progression
The Case for All Parkinson’s Disease Patients to be Co-managed by a Primary Care-Neurologist Team
Scientists say Research on Brain Proteins Involved in Parkinson’s Disease is “Shaping” Up
Who Actually Takes Care of Most of the Parkinson’s Patients Worldwide: The Need for Education and the Parkinson’s Toolkit
If you are Dizzy or Passing Out, it could be Your Parkinson’s Disease or Parkinson’s Disease Medications
How Will Group Visits for Parkinson’s Disease Fit into the Future of Parkinson’s Disease Care?
Why Patients Should be Wary of Chelation Therapy for Parkinson’s Disease
Opening the Door to Gene Therapy in Parkinson’s Disease: The Need for Refinement of the Technology and Approach
Does it Matter if I Can’t Get Brand Sinemet?
Should I get a DaTscan or PET scan to confirm my diagnosis of Parkinson’s disease?
A Critical Reappraisal of the Worst Drugs in Parkinson’s Disease
Environmental Risks for PD: Manganese, Welding, Mining, and Parkinsonism
Calling for the FDA to Revise the Eight Sinemet a Day Rule
Dry Cleaning Solvents and Potential Environmental Risks for Developing Parkinson’s Disease
Maintaining the Balance: Why Parkinson’s Disease Patients Need to Understand Drug Recalls, Withdrawals, and Safety Alerts
Shining a Light on Parkinson’s Disease: Optogenetics Has a Bright Future in Research
Poor Medication Management of Parkinson's Disease During Hospital Admissions: Patients and Families Can Improve Their Hospital-Based Management
Why Are Patches and Continuous Release Technology a Big Deal to Parkinson's?
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Cycling in PD in Those Who Can’t Walk: Is it Possible?
New iPS Stem Cells for PD: What Does it Mean?
Time for Comprehensive Care Networks for PD
Is Parkinson's Disease a Prion Disease?
Parkinson's Disease Linked to Gaucher's Disease
Brain Cells Keep Time Stamps: Implications for Parkinson's Disease Therapies
Is it Safe to Have an MRI with a DBS in Place?
Take Care of Your Bones as They Are Affected in Parkinson's Disease (Even in Men)
Is it Time to Start Paying Attention to Pain Symptoms in Parkinson's Disease Patients?
Glutathione Fails to Demonstrate Significant Improvement in PD Symptoms
Keeping an Eye on Trials Important to the Parkinson's Disease Patient
Increased Risk of Melanoma in Parkinson's Disease
Finally a DBS Expert Consensus Statement Aimed at Their True Customers: The Patients
Pesticides and Environmental Exposure in Parkinson's disease: Should We Stay Away From the Stink Truck?
Is Exercise Effective Treatment and Protection Against PD?
Why are Transplant Trials Struggling to Succeed in the Treatment of PD?
Are Monoamine Oxidase Inhibitors Disease Modifying or Neuroprotective in PD?
Update on Gene Therapy for Parkinson's Disease