Medical Services Utilization and Prognosis in Parkinson Disease: A Population-Based Study

Abstract

Objectives To investigate prognostic outcomes and utilization of medical services by patients with Parkinson disease (PD) and to identify predictors of such use. Patients and methods Using the medical records linkage system of the Rochester Epidemiology Project, we identified an incidence cohort of 89 PD cases (Olmsted County, Minnesota, 1979-1988) and a reference group of 89 subjects without PD of the same age and sex and from the same population. Both patients with PD and reference subjects were followed up historically by medical record review from onset of PD (or index year) through death, last contact with the system, or end of study. Results Patients with PD had significantly more physician consultations per year (median, 7.9 vs 5.9; P=.001) and more emergency department visits per year (median, 0.6 vs 0.4; P=.05) than did reference subjects. Response to dopaminergic medications and higher education predicted more physician consultations among patients. The PD patients used neuroleptics and antidepressants significantly more frequently than reference subjects. The risk of nursing home placement was significantly increased for PD patients compared with reference subjects (relative risk, 6.7; 95% confidence interval, 3.7-12.1; P<.001). Poor response to dopaminergic medications, lower education level, older age at onset of PD, and dementia predicted a shorter time between onset and nursing home placement among PD patients. Survival was significantly reduced in PD patients compared with reference subjects (relative risk, 2.2; 95% confidence interval, 1.4-3.4; P<.001). Good response to dopaminergic medications, higher education, younger age at onset of PD, and absence of dementia predicted better survival among PD patients. Conclusions Patients with PD used outpatient and nursing home services more often than subjects without PD. Patients with PD also experienced a reduced survival time. Demographic and clinical characteristics influenced utilization patterns and outcomes.