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Neurologist Care May Reduce Parkinson's-Related Hospitalizations

Regular visits to a neurologist may reduce a person's risk of hospitalization for illnesses related to Parkinson's disease (PD), according to a new study published online in Neurology on October 10, 2012. Seeing a neurologist could also reduce health care costs for people with Parkinson's disease, the researchers say. 

During their education, neurologists receive specialized training in PD and other diseases that affect the brain. As a result, neurologists may be able to prevent, recognize or treat symptoms of PD and related illnesses better than a primary care physician. In fact, previous research by Allison Willis, M.D., and her coworkers at the Washington University School of Medicine showed that people with PD who regularly visit a neurologist are less likely to die over the six-year period following their PD diagnosis.

This finding led Dr. Willis and her coworkers to ask whether regular neurologist care could also reduce the risk of serious PD-related illnesses that require hospitalization. Such illnesses include dementia, depression, psychosis and injuries from falls. People with PD also have an increased risk of urinary tract infections because the disease can kill nerve cells that control the bladder.

To find out more, Dr. Willis' team used data available from Medicare records, identifying 24,929 Medicare beneficiaries who had been diagnosed with Parkinson's disease in 2002 and were still alive on January 1, 2006. Of those, 13,480 had received care from a neurologist. With that in mind, the researchers classified the people into groups according to their level of neurologist care during this four-year period: infrequent (no neurologist visits), intermediate (between one and five outpatient neurologist visits), and frequent (more than five visits). They then examined the Medicare records to identify which individuals had been hospitalized during the four-year period for psychosis, neurodegenerative disease, urinary tract infection, traumatic injury or depression.

Results

  • During the four-year observation period, 21.3 percent of people with PD were hospitalized at least once for a PD-related illness. Neurologist care reduced the risk of hospitalization for psychosis, traumatic injury, and urinary tract infection. Among the three study groups, people with frequent neurologist care were the least likely to be hospitalized for these illnesses.
  • Neurologist care did not reduce the risk of hospitalization for neurodegenerative disease or depression, or for illnesses unrelated to PD such as hypertension or congestive heart failure.
  • Six percent of those included in the studies, or nearly 1,433 people, were hospitalized more than once for a PD-related illnesses. Except in cases of traumatic injury, neurologist care reduced repeat hospital visits.
  • People with Parkinson's disease who frequently saw a neurologist had the lowest overall health care costs, including costs associated with hospitalization, skilled nursing facilities, medical equipment, home health care, and hospice care, as compared with those in the infrequent and intermediate groups.

What Does It Mean?

This study has two major findings. The first is that people with PD who are seen by neurologists on a regular basis do better than those who are treated by primary care physicians. The second finding, which may be more surprising, is that regular neurologist care can reduce PD-related health care costs. The reason for the improved outcomes is the fact that people with PD seen by neurologists regularly are less likely to be hospitalized. People who visited a neurologist frequently (more than five times in four years) saw the greatest benefits.

Compared with primary care physicians, neurologists have more extensive training in brain disorders like PD. Therefore, they may be able to recognize and treat symptoms of PD-related illnesses earlier than primary care physicians, reducing the need for hospitalization. Better management of PD-related illnesses could help explain why people who regularly see a neurologist show better survival in the six years following PD diagnosis.

For example, people with PD have an increased chance of urinary tract infections. However, their symptoms can be very different from those of people without PD and may include worsening of PD motor symptoms, psychosis and confusion. Physicians without specialized training in neurology may not recognize these atypical symptoms of urinary tract infection. On the other hand, neurologists could more quickly diagnose and treat urinary tract infections in people with PD, avoiding hospitalization. Likewise, neurologists may be able to more effectively prevent, recognize, and treat psychosis and injuries related to PD.

In contrast, neurologist care did not reduce the risk of hospitalization for depression. This result could be explained by the fact that primary care physicians are very familiar with the screening and treatment of depression in the general population, so that seeing a neurologist provides no additional benefit.

Like all studies, this one has some limitations. Differences among people in the three groups, such as severity of PD motor symptoms, personal health behaviors, or beliefs, may have influenced whether a person was likely to seek neurologist care or be hospitalized for PD-related illness. In addition, some people in the "infrequent" group may have been too ill to visit a neurologist, possibly skewing the results. Therefore, additional research that addresses these potential complications in other populations is needed to confirm these results.

Despite these limitations, however, this study highlights the importance of promptly recognizing and treating PD-related non-motor symptoms to reduce hospitalization and health care costs. The study also provides evidence supporting the American Academy of Neurology's recommendation of yearly neurologist visits for people with PD.

Reference: Allison W. Willis, Mario Schootman, Rebecca Tran, Nathan Kung, Bradley A. Evanoff, Joel S. Perlmutter, and Brad A. Racette. Neurologist-associated Reduction in PD-related Hospitalizations and Health Care Expenditures. Neurology 2012, published online October 10.

 

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Source Date: Oct 19 2012