“Medication Issues in the Ambulatory Setting”). They do also mention self-medication as a possibility, though our own bias is that introduces too many risks in this setting. Ideally, in the age of CPOE and EMR’s, rules-based alerts could alert the physician or pharmacist or nurse about critical issues in this patient population. Unfortunately, clinical decision support systems currently in use in most hospitals have difficulty using diagnoses (particularly secondary ones as would be the case here) to trigger actions. Theoretically, one could probably identify most Parkinson’s patients by their medication profile and perhaps use that to trigger alerts. Maybe anti-Parkinsonian medications need to be added to your list of high-alert drugs!
The peripherally related article that jogged our memory about the above paper was one on medications prescribed for psychosis in Parkinson’s patients on an outpatient basis (Weintraub 2011). That study showed a large number of patients are treated with antipsychotic drugs that either may worsen the motor findings, have unproven or limited efficacy in patients with Parkinson’s, or are prescribed despite black box warnings about their use in patients with dementia. It is an interesting article about how some drugs become widely prescribed in certain populations despite evidence bases that suggest limited efficacy.
Parkinson’s is a tough disease for patients and their families/caregivers. The complexities and fragmented nature of our healthcare system further exacerbate the difficulties they have.