Pharmacists’ role in managing Parkinson’s disease

Parkinson’s disease is in the limelight this month, with World Parkinson’s Day on 11 April inspiring a series of events around the world to raise awareness and funds for the debilitating disease. With the prevalence amongst Australians set to increase in the coming years, pharmacists are ideally placed to play a pivotal role in optimising treatment outcomes.

There is no known cause of Parkinson’s disease. Current treatments only address symptoms, not disease progression, although clinical trials for future treatments are in the pipeline. The disease, the second most common neurodegenerative disorder after Alzheimer’s disease, is often managed with numerous prescription medicines that vary between patients. Treatment can involve multiple daily doses and complex regimens.

Michael Bakker, Team Leader Aged Care, Rehabilitation and General Medicine at SA Pharmacy and Board Member of Parkinson’s SA, noted that it can be challenging for patients to understand the pressing need for medicine compliance in the early stages of the disease.

‘In the mild stages of the disease, people often won’t notice an impact from delayed medicines or even missing a single dose, but the importance of timely administration is significant in fragile disease control,’ he told Australian Pharmacist.

Mr Bakker said that pharmacists are ‘perfectly trained and positioned’ to address medicine compliance in Parkinson’s patients, but noted that simply providing patients with information does not guarantee optimal outcomes.  

‘The first step to changing poor medicines behaviour is to understand why the individual is taking that path. Don’t presume that lumping them with more information on what they should be doing will influence their actions,’ he said.

He also cited the need for pharmacists to be aware of current research, which can change their advice for patients.

Mr Bakker noted that there is a thought in the community that Parkinson’s disease is a set of diseases/symptoms that present very similarly, and that until now we have not been able to determine differences between them.

Because of different presentations of the disease, individual patient experiences can be highly variable. Therefore, medication regimens often vary significantly amongst patients. Also, diagnoses can change over time.  

Mr Bakker said that, ‘as healthcare providers, we need to understand this ourselves and also help the consumer to understand it. A pragmatic approach without trying to map the expected course of the disease is the healthiest outlook I could encourage’.

To accomplish this, he encouraged pharmacists to listen to their patients. Noting that they often have a more detailed understanding of their symptoms than healthcare professionals.

Pharmacists can also provide meaningful support by helping patients understand which aspects of their experience with the disease are affecting their adherence and response to the medicines.

Pharmacists could encourage patients and carers to keep a symptom diary. Mr Bakker advises that patients shouldn’t fixate on symptoms. Rather, recording daily activities, food intake and general health can provide better insight into factors affecting adherence. This record can also provide signs that precede noticeable deterioration.

The variable nature of the disease highlights the importance of the interpersonal relationship that pharmacists build with their patients.

‘Get to know the person, not the disease. Understand that someone who presents may well be fighting internally to appear as ‘normal’ as they can’, Mr Bakker said.

Learn about people living with Parkinson’s disease in a palliative care setting in PSA’s Palliative Care Essential CPE.