Medication Therapy Management Service for Patients with Parkinson’s Disease: A Before-and-After Study

Neurol Ther (2016) 5:85–99 DOI 10.1007/s40120-016-0046-4 ORIGINAL RESEARCH Medication Therapy Management Service for Patients with Parkinson’s Disease: A Before-and-After Study Aline Aparecida Foppa . Clarice Chemello . Claudia Marcela Vargas-Peláez . Mareni Rocha Farias Received: March 19, 2016 / Published online: June 7, 2016 Ó The Author(s) 2016. This article is published with open access at Springerlink.com ABSTRACT Objective: To analyze the effect of MTM upon Background: Parkinson’s disease (PD) is a medicine-related problems, motor symptoms, autonomic disorders and QoL of patients with neurodegenerative Parkinson’s disease motor manifestations, neurological disorders characterized by autonomic and and sensorial disease, and describe pharmaceutical interventions. Methods: Quasi-experimental the uncontrolled symptoms. Medication therapy management (MTM) consists of a service undertaken by before-and-after study carried out between September 2012 and March 2013 in a pharmacists pharmacological community pharmacy. Pharmacotherapy data therapy results. This way, the pharmacist monitors the treatment prescribed by the were collected from medical prescriptions, patient diaries, medical charts and all the doctor and formulates a healthcare plan to guarantee the treatment’s effectiveness, safety medicines (over-the-counter and prescription) brought by the patients to the appointment and with the pharmacist. The medicine-related to convenience, optimize thereby improving the patient’s quality of life (QoL). problems were classified as effectiveness, safety and Enhanced content To view enhanced content for this article go to http://www.medengine.com/Redeem/ 66D4F060318369C4. Adherence was measured through clinical interviews and the Morisky questionnaire. PD indication, adherence. symptoms were assessed according to the A. A. Foppa (&) Farmácia Escola UFSC/PMF, Post-Graduate Program in Pharmaceutical Assistance, UFSC, Florianópolis, SC, Brazil e-mail: patients’ and/or caregivers’ perceptions about the On/Off state of the motor symptoms and C. Chemello Department of Social Pharmacy, Faculty of Pharmacy, UFMG, Belo Horizonte, MG, Brazil interventions C. M. Vargas-Peláez
M. R. Farias Department of Pharmaceutical Sciences, Health and Science Center, UFSC, Florianópolis, SC, Brazil relief of the nonmotor symptoms. QoL was assessed using the PDQ-39 scores. The were targeted to patients/caregivers and/or doctors, with pharmacological and non-pharmacological measures. Neurol Ther (2016) 5:85–99 86 Results: Seventy patients were followed up, complications (dyskinesia and fluctuation) and showing a decrease in medicine-related problems (1.67 ± 1.34 to 0.8 ± 0.9 (p\0.001), educational attainment [2]. positive impact on adherence (from 37 to 10 non-adherent patients, p\0.001), QoL improvement related to emotional wellbeing (p = 0.012) and autonomic disorder. Most interventions were performed directly with the patients (73.8%), including non-pharmacological guidance (28.5%), pharmacological guidance (24.3%) and rescheduling (13.6%). Conclusions: To carry out MTM with PD patients, the pharmacist’s expertise needs to transcend the technical knowledge about the PD pharmacological treatment. The study showed a positive effect with a decrease in the medicine-related problems after the interventions, especially improving adherence Therapy for PD is effective in the treatment of motor symptoms, but it does not prevent the disease’s progression. The worsening of motor symptoms associated with the occurrence of non-motor symptoms evolves progressively. This situation leads to dosage increase and need of new medication. Some antiparkinsonians, mainly levodopa, develop motor complications (fluctuation and dyskinesia) in the long term, making the treatment complex, increasing the demands for care and more expensive and invasive procedures [5, 6]. As a result of the treatment, PD patients can experience medicine-related problems, which and patients’ QoL. are also called DRPs—drug-related problems. ‘‘A DRP exists when a patient experiences (or is Keywords: Parkinson disease; Pharmaceutical likely to experience) either a disease or symptom having an actual or suspected care; Medication therapy management relationship with drug Medicine-related problems INTRODUCTION related to medicine therapy’’ [7]. include issues effectiveness, adverse Parkinson’s disease (PD) is a neurodegenerative reactions and non-adherence to the treatment. Non-adherence to the treatment is one of the disease characterized by motor manifestation, autonomic disorder, sensorial symptoms and most common medicine-related problems in patients who suffer from chronic diseases. It has neurological disorder that compromises the been estimated that the PD patients’ adherence patient’s quality of life (QoL) [1, 2]. Due to the progressive nature of the disease, to the treatment is only 39%, compromising the benefits of the therapy [6]. Younger patients, the patient’s QoL is compromised in physical, mental/emotional, social and economic aspects. patients with complex therapeutic regimens (several pills per day), high depression, and low The most common and relevant factors reviewed in the literature about the worsening QoL are less adherent to the antiparkinsonian of PD patients’ QoL were bradykinesia, tremor, treatment [8–10]. Clinical consequences of non-adherence to the antiparkinsonian rigidity, postural instability, gait disorder, pain, fatigue, depression, and sexual and cognitive treatment include loss of motor functions and reduction in QoL [11, 12]. The commitment of disorders [3, 4]. A Brazilian study showed that the major QoL determinants include mood health professionals and patients together disorder (mainly depression), disability, PD contributes adherence to improvement [5, 8, 13]. of treatment Furthermore, Neurol Ther (2016) 5:85–99 non-adherence 87 costs pharmacy (a training unit) linked to the because of the increase in hospital admissions, increases pharmacy undergraduate course at the Federal medical appointments and other healthcare services [6]. University of Santa Catarina and to the Municipal Health Secretariat in Florianopolis, Brazil. This Some studies have reported that the participation of a pharmacist in a community pharmacy dispenses the medicines included in the Specialized Component of multidisciplinary healthcare team promotes Pharmaceutical clinical benefits for PD patients and is considered a valuable healthcare strategy Brazilian Unified Health System (SUS). The SCPA aims to guarantee the integrality of the [14, 15]. Medication therapy management (MTM) is one of the pharmacist’s duties, pharmacological treatment, especially for chronic diseases whose medications have a high which consists of a service undertaken by the cost or are of difficult access in the market. The pharmacist in (...truncated)