June 20, 2016
Only 11% of patients had used it in Medicare study
BERLIN
-- Patients with Parkinson's disease aren't taking advantage of the physical,
occupational, and speech therapy available to them, researchers reported here.
Only
about 11% of Parkinson's patients on Medicare had claims for physical or
occupational therapy and only about 12% had claims for speech therapy, Michelle
Fullard, MD, of the University of Pennsylvania, and colleagues
reported at the Movement
Disorders Society meeting here."
This
is very positive support for something that many feel is a problem, that allied
healthcare is highly underutilized," Peter Schmidt,
PhD, of the National Parkinson Foundation, who wasn't involved in
the study, told MedPage Today.
Multiple
studies have demonstrated the efficacy of physical, occupational, and speech
therapy -- collectively known as allied healthcare -- in Parkinson's disease.
Physical therapy, for instance, has been shown in randomized controlled
trials to improve motor function and independence and reduce falls in this
population, the researchers said.
But
no study has yet examined allied healthcare utilization among Parkinson's
patients in the U.S. So Fullard and colleagues conducted a cross-sectional
study using Medicare claims data from 2007 to 2009, totaling 742,846 Medicare
beneficiaries with Parkinson's.
The
researchers found that there were several factors that were associated with use
of allied healthcare. Race was one such factor, with Asian Americans having the
highest likelihood of use (adjusted odds ratio 1.52 for physical/occupational
therapy, 1.45 for speech therapy, compared with white patients) while African
Americans had the lowest (aOR 0.67 for physical/occupational therapy, 0.67 for
speech therapy).
Parkinson's
patients who were under the care of a neurologist care had increased
utilization of allied healthcare. Those who had at least one neurologist visit
per year had a higher likelihood of receiving an evaluation for
physical/occupational therapy (aOR 1.31) and speech therapy (aOR 1.52) compared
with those who hadn't seen a neurologist.
allied
healthcare use were more common in states with reduced availability of allied
healthcare providers. The researchers called for further research in order to
identify the barriers to these therapies for Parkinson's patients.
Schmidt
noted that one such barrier is a therapy cap that limits patients to about a
month's worth of occupational therapy, and a similar month's worth of combined
physical and speech therapy.
"In
order to get patients beyond a month of physical, occupational, or speech
therapy, you have to ask for an exception, and the physician has to fill out
paperwork, which creates an administrative burden," he said.
Schmidt
added that there are sufficient data to show that physical therapy in the long
run benefits patients with Parkinson's – even if that just means a slower
degradation of their condition.
"Occupational
and physical therapy can help patients with being able to exercise, and we know
that's one of the most effective ways to reverse the course of
Parkinson's," he said. "We've also shown that the earlier you get it,
particularly with physical therapy, the more effective it is later in the
disease."
http://www.medpagetoday.com/MeetingCoverage/MDS/58655?
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