Medication Review in Patients on Anti-parkinson Therapy
Medication Review in Patients on Anti-parkinson Therapy
To identify patients within the community taking anti-parkinson medications in whom the
 diagnosis of Parkinson's disease is incorrect and to supervise and clinically monitor the
 withdrawal of anti-parkinson medications in this patient group
Step 1 - Practice based pharmacist and medical review using database search for the
 following:

 -  Anti-parkinson drug therapy (excluding anticholinergic monotherapy).

 -  Disease codes to identify Parkinson's disease and parkinsonism, and exclude other
 diagnoses where anti-parkinson therapy may be used, although both are expected to be
 very small numbers (pituitary tumour, restless leg syndrome)

 -  To identify the duration of parkinsonism from the date of entry of the disease code.

 -  Pharmacy re-fill data to identify intermittent usage of treatment as an indicator of it
 being unlikely that the patient has idiopathic or dopa responsive parkinsonism.

 -  To identify patients on monotherapy with anti-parkinson therapy e.g. Selegiline for a
 prolonged duration as this is likely to suggest an alternative diagnosis.

 -  To record drug dosage over time, e.g. on an annual basis, again to identify whether
 patients fit in with the expected rates of change for degenerative parkinsonism where
 increasing combinations of drugs at higher doses are used over time.

 Step 2 - Review of case records:

 · Parkinson's disease nurse specialist and medical review of case records to identify
 additional clinical features of the condition and assist in identifying cases where it
 appears likely that anti-parkinson drug treatment is not helping the patient's condition.

 Step 3 - Specialist out-patient review and follow-up:

 · Invitation to the patient to attend the combined neurology/medicine for the elderly
 movement disorder clinic service where scoring against diagnostic clinical criteria would be
 undertaken, and where appropriate tapering of anti-parkinson therapy gradually under
 continued specialist observation.
Inclusion Criteria:

 Patients on anti-parkinson medication who:

 -  Have been on monotherapy for a prolonged period, or

 -  Use anti-parkinson medications intermittently, or

 -  Do not have the expected change in medication over time in keeping with degenerative
 Parkinson's disease.

 Exclusion Criteria:

 -  Patients on anti-parkinson medication for reasons other than Parkinson's disease.

 -  Patients with significant co-morbidity (end stage liver, cardiac or renal disease).