PhD Defence Nicol Oonk | Optimizing medication management for Parkinson’s patients in primary care - Challenges, opportunities and future perspectives

Optimizing medication management for Parkinson’s patients in primary care - Challenges, opportunities and future perspectives

Nicol Oonk is a PhD student in the department Cognition, Data and Education. (Co)Promotors are prof.dr. J.A.M. van der Palen from the faculty of Behavioural, Management and Social Sciences and dr. L.D.A. Dorresteijn and dr. K.L.L. Movig from MST.

Drug therapy is important for controlling the broad variety of symptoms in Parkinson’s disease (PD). However, this often leads to complex medication regimens, resulting in suboptimal adherence, drug-related problems (DRPs), reduced therapy efficacy, and a subsequent decline in quality of life (QoL). A structured medication review (SMR), defined as a structured, critical examination of a patient’s medicines aiming to reach an agreement with the patient about therapy, optimizing the impact of medication, minimizing the number of drug-related problems, and reducing waste, could potentially address these issues. SMRs are routinely conducted as part of standard care by Dutch community pharmacists; however, it remains uncertain which patients primarily benefit from this practice.

In this thesis, different aspects of an SMR in PD patients were studied. In a general, home-dwelling PD patient population, SMRs were not found of added value regarding clinical effects and costs. Despite the experienced added value of pharmacists in providing personalized care and potential long-term benefits, major concerns were time and logistic constraints, as well as cooperation with medical specialists.

Since we do not doubt the importance of periodic medication optimization in complex diseases or high-risk patients, the future focus should be on either improving the current setting of SMRs in PD or exploring alternative strategies to achieve this goal. Building upon our findings and previous research, we propose an optimized patient selection process, driven by the evaluation of healthcare providers within a multidisciplinary team, with a specific focus on risk factors related to PD. We recommend optimizing (digital) communication between healthcare providers and advocate for increased visibility of community pharmacists with expertise in PD within the multidisciplinary care team. This approach facilitates shorter communication lines and closer cooperation with the regional movement disorder neurologist, as well as with other involved healthcare providers. The extensive SMRs for a selective group of PD patients could then be conducted either by these community pharmacists or by pharmacists working in the PD outpatient clinic. Additionally, the integration of Pharmabuddy care teams, comprising a PD-trained pharmacy technician and pharmacist, could offer significant added value and a sustainable solution for logistical challenges, facilitating low-threshold pharmacy care monitoring and enhanced patient satisfaction.