Objective: We aim to study the outcomes of a telehealth service that provides telephone follow-up of PwP who have adjustments to their PD medications.

Background: Patients with Parkinson disease (PwP) suffer from motor fluctuations in the mid stages of disease. Increases in dopaminergic medications can potentially cause side effects (SE) that can lead to non-adherence or adverse outcomes. PwP are usually seen at 6 monthly intervals, resulting in episodic care and missed opportunities to detect complications.

Method: The Telecare Programme at Changi General Hospital, a large tertiary hospital in Singapore supports systems-wide, population-based approaches for proactive chronic disease management. Telecare nurses are senior nurses who have experience providing telephone follow-up and management of complex disorders. Nurses underwent training in specific aspects of PD care and followed a script to enquire about medication adherence and SE, 2 weeks after medication adjustment at the neurology clinic visit. Outcome measures were evaluated using Fisher’s exact test for rates of adherence, SE and emergency department visits and unplanned admissions between clinic visits.

Results: A total of 112 PwP were enrolled, of which 89 (80%) completed at least 1 call (active group). Medication non-adherence was noted in 17 (19%) patients and 23 (26%) reported SE from adjusted medications, of which 12 had to be escalated to the liaison team or primary neurologist, including dyskinesia (1), hallucinations (1) and orthostatic hypotension (6). Only 1 (4.3%) patient in the control group (patients who rejected the programme/ were uncontactable) called in to report medication SE (p=0.02). Compared to the control group, more patients in the active group had their medications adjusted before the next visit (0 vs 7, 7.9%; p=0.34). The active group had 3 (3.4%) ED visits and unplanned admissions each, while the control group had 1 (4.3%) each (p=1.0).

Conclusion: Telephone follow-up for PwP with medication adjustments had high completion rates. A significant proportion had SE that required escalation to their healthcare team. While rates of ED visits and unplanned admissions were not statistically significant due to small numbers, medication nonadherence was picked up in a timely manner in 19% of the active group. PwP require closer monitoring during periods of medication adjustment and will benefit from telemonitoring.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/utility-of-telephone-follow-up-of-pd-patients-with-medication-adjustment/