Pharmacist-led telephone intervention keeps people with Parkinson’s disease out of emergency department

A pharmacist-staffed telephone intervention service significantly reduced the number of visits patients with Parkinson’s disease made to the emergency department. The telephone intervention is part of North York General Hospital’s specialized geriatric clinic for patients with Parkinson’s disease. The telephone intervention program evolved naturally, because patients were calling the clinic and Greta Mah, a clinical pharmacist, was answering the calls since patients already knew her from regular consultations. “I thought, since I’m answering all these phone calls, I want to capture this special work and see if it is making a difference,” she said. Mah is also serves as the clinical pharmacist for the geriatric day hospital. Mah and colleagues looked at data from all calls to the clinic in 2016. There were a total of 337 calls concerning 114 patients, with the majority of calls coming from caregivers. Twenty-four percent of calls were crisis calls, where the caller was considering going to the emergency department. Of those calls, 93% resulted in avoiding a trip to the emergency department. “A lot of time, by adjusting the medication, we can resolve the issue,” Mah said. The telephone intervention program serves patients with complex needs. The average age was 80 years old. Patients were on an average of ten medications, with 44% on more than 11 medications. Mah said while three of these medications may be for Parkinsonian symptoms, the other medications usually treat other symptoms or illnesses, such as diabetes, enlarged prostate or hypertension. More than half the patients had one or more comorbidities, and 43% had more than 10 comorbidities. While 18% of the calls were about motor symptoms, another 27% were about non-motor symptoms and 21% about adverse drug effects. Other callers were seeking drug information or counselling, referral for services or medication refills. Read: Parkinson Disease: A management update for pharmacists Mah said that she listens to the symptoms and see if it may be caused by medications or could be helped with a change of medication. Patients with Parkinson’s disease often have fluctuating blood pressure, impaired bowel function, weakened bladder control or frequent urination. In many cases, “if it is not managed sooner, it can become a medical emergency,” Mah explained. Sleep disruptions such as insomnia or frequent waking is another common complaint. There is often a risk of dementia, which could leave to visual hallucinations or agitation. “We want to prevent this type of hallucination before it gets too severe,” she said. Mah said that caregivers may not don’t know what to do so they call 911. For example, patients can faint in the morning because of orthostatic hypotension, and if caregivers call the clinic prior to calling 911, the hypotension can be managed and further episodes can be prevented. Mah and colleagues circulated a user satisfaction survey. They found that 97.4% of patients were satisfied with the telephone intervention service, and 92% of callers agreed or strongly agreed that they had enough confidence in the telephone intervention service that they would always contact the clinic before going to the emergency department. “It is very encouraging to know that when we had the anonymous survey provided to the patients, they gave such a high ranking. That is very reassuring.” Read: Waiting for treatment taking toll on patients with chronic illnesses Mah has been involved in the geriatric clinic for Parkinson’s since its inception in 2007. She has training in geriatric pharmacy and completed a course by the American Parkinson’s Foundation. Mah said she thinks that she might be the only Canadian pharmacist with training in geriatric medicine to specialize in Parkinson’s care. Any pharmacist can apply and get certified with the Parkinson’s Foundation, she said. Mah also shadowed neurologists as part of her training. “In this clinic setting, I have a lot of connections with neurologists,” she said. She is also the coordinator for the Fanny Bernstein Living Well with Parkinson’s Education and Exercise Program. “Over the last 15 years I’ve seen thousands of people with Parkinson’s,” she said. Some clinics have pharmacists take a medication history, but Mah said that pharmacists can do more. “I feel that the training of pharmacists is underutilized.” Statistics Canada and the Public Health Agency of Canada estimate that the number of people with Parkinson’s disease will double to more than 163,700 between 2011 and 2031. The incidence of increases with age, and 85% of people diagnosed with Parkinson’s are more than 65 years old. As the number of elderly patients with Parkinson’s grows, there is a greater need to focus on these patients, especially when there’s polypharmacy, Mah said. “We see the need to encourage this model to be adopted in other healthcare centres or movement disorder centres. They need to put a special focus on the elderly population, because we’re not just dealing with one disease, we’re dealing with a lot of these so-called non-physical symptoms,” she said. Read: Managing sleep disturbances in Parkinson Disease She noted that people with Parkinson’s disease have high rates of hospital admission and readmission. Studies have shown that a main reason for hospitalization is adverse effects of medications. “If the hospital wants to put money into a group of patients to prevent them from coming back, I would say, people with Parkinson’s and seniors definitely deserve that special attention,” Mah said. The study was published in a recent issue of The Canadian Journal of Neurological Sciences.

Pharmacist-led telephone intervention keeps people with Parkinson’s disease out of emergency department

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