Inappropriate Prescribing Protocols in Parkinson Disease

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Women were less likely to be prescribed medication for dementia than men.
Women were less likely to be prescribed medication for dementia than men.

Inappropriate prescribing may be common in individuals with Parkinson disease who are being treated for cognitive impairment, according to study results published in JAMA Neurology.

Researchers collected demographic, geographic, and prescription claims information pertaining to 268,407 adults with Parkinson disease who were Medicare beneficiaries and aged 65 years or older. Researchers focused on the use of dementia drugs, specific dementia medications, and parallel exposure to a high-potency anticholinergic drug and an acetylcholinesterase inhibitor (ACHEI) to gauge the possibility of inappropriate prescribing protocols by demographic.

Approximately half of the study participants were men, 86.7% were white, 5.5% were black, 2.7% were Hispanic, 2.7% were Asian, and an additional 0.3% were Native American. Dementia drugs were more likely to be prescribed to black participants (adjusted odds ratio [AOR] 1.33; 95% CI, 1.28-1.38) and Hispanic participants (AOR 1.28; 95% CI, 1.22-1.35) compared with Native American participants (AOR 0.62; 95% CI, 0.51-0.74). Women compared with men were less likely to be given a prescription for dementia medication (AOR 0.85; 95% CI, 0.84-0.87). Black participants were less likely to have simultaneous high potency anticholinergic and ACHEI prescriptions (AOR 0.83; 95% CI, 0.77-0.89) compared with whites. Hispanic participants (AOR 1.11; 95% CI, 1.00-1.23) and women (AOR 1.30; 95% CI, 1.25-1.35) had greater odds of experiencing this never event. Statistically significant clusters of prescribing errors were also noted across the United States (Moran I=0.24; P <.001), with higher clusters in the Southern and Midwestern states.

"Dementia medication use by persons with Parkinson disease varies by race/ethnicity and sex; potentially inappropriate prescribing is common among those being treated for cognitive impairment and varies by race/ethnicity, sex, and geography," researchers concluded. Researchers hope their findings will improve care and outcomes for individuals with Parkinson disease.

Reference

Mantri S, Fullard M, Gray SL, et al. Patterns of dementia treatment and frank prescribing errors in older adults with Parkinson disease [published online October 1, 2018]. JAMA Neurol. Doi: 10.1001/jamaneurol.2018.2820

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