Study of home visits examines patient characteristics in advanced Parkinson’s disease
Patients with advanced Parkinson’s disease who enrolled in a study about home visits tended to be older and more racially diverse, according to findings presented at the Annual Meeting of the American Neurological Association.
These patients also experienced a greater degree of motor impairment, study results demonstrated.
“As Parkinson’s disease progresses, symptoms increase in number and severity and patients can become homebound,” the researchers wrote. “Our knowledge of advanced [Parkinson’s disease] is based on outpatient visit attendance. The most disabled are estranged from care and research.”
Jori Fleisher, MD, MSCE, an associate professor in the department of neurological sciences at Rush Medical College, and colleagues aimed to identify sociodemographic differences between patients who receive care via home visits or in an outpatient clinic. The researchers also aimed to determine whether disparities in care and research among minority patients continued after a patient-centered, care-focused intervention. They conducted a cross-sectional analysis of demographic characteristics of patients with advanced Parkinson’s disease.
The study included 65 patients who received home visits and 1,015 patients who attended outpatient clinics between 2017 and 2019.
Fleisher and colleagues found that patients who were homebound were older compared with patients who received care in an outpatient clinic (mean age, 78.9 years vs. 75 years; P = .0001), more racially diverse (non-white, 25% vs. 14.7%; P = .03) and more likely to require an assistive device or be wheelchair or bed bound (Hoehn & Yahr stage 4 or 5, 78.5% vs. 39.6%); P < .0001).
The researchers also noted that, in the absence of a novel framework for care, older patients with more advanced disease, as well as those from underrepresented minorities, may have experienced loss to follow-up sooner. However, these patients were amenable to participating in a patient-centered intervention, Fleisher and colleagues found.
“Despite underrepresentation of [patients with advanced Parkinson’s disease] in clinical care and observational research, and evidence of disparities in diagnosis, referral and access to advanced therapies among [patients with Parkinson’s disease] from underrepresented backgrounds, disparities in continuity of care for these groups have not been previously demonstrated,” the researchers wrote. “Future work must define and address disparities in access to and continuity of care for all patients with advanced [Parkinson’s disease], and particularly those from underrepresented minorities.”