Evaluation of the clinical guidelines –⁠ diagnosis and treatment of Parkinson‘s disease from the perspective of experts in clinical practice

Overview

Aims: Adapted Clinical Practice Guidelines (CPG) covering diagnostic and therapeutic procedures for patients with Parkinson‘s disease were developed in 2022. The recommendations are intended to assist clinical practitioners in their decision-making abilities, and the CPG aims to improve the quality of services provided nationally including cost-effectiveness. Methodology: A retrospective questionnaire survey to examine the use of CPG by clinical practitioners (physicians and non-physician health professionals). Data collection was conducted from early June to late July in 2023 by sharing it electronically on the Czech Neurological Society (CNS) web portal and the Extrapyramidal Section of the CNS. A self-constructed questionnaire was used and data were analyzed using descriptive analysis. Results: A total of 51 respondents (30 women and 21 men) took part in the survey with an average age of 43.3 years. There were 31 physicians, i.e. 61% (12 ambulatory care and 19 inpatient care) and 20 nurses, i.e. 39% (11 ambulatory care and 9 inpatient care) with an average length of clinical experience of 15.2 years. None of the general nurses reported full use of CPG compared to physicians, where 6 of them reported using CPG (P = 0.036) and rated it as high quality. Other suggestions for updating the CPG included the addition of new medicines (N = 5) and comprehensive development of patient information (N = 2). Conclusion: Parkinson‘s disease represents a significant economic burden on healthcare systems and a reduction in quality of life for patients as the disease progresses. The national CPG aims to reduce geographic, demographic, and other disparities in patient access. Regular updates to the CPG on the diagnosis and treatment of Parkinson‘s disease will be implemented as required by the Extrapyramidal Section. Recommendations will be updated with the latest registered drugs and diagnostic and therapeutic procedures, and comprehensive recommendations for patients in lay language will be prepared as part of the update.

Keywords:

diagnosis – treatment – Parkinson‘s disease – guidelines – clinical practice

This is an unauthorised machine translation into English made using the DeepL Translate Pro translator. The editors do not guarantee that the content of the article corresponds fully to the original language version.

 

Introduction

In 2022, a Clinical Recommended Practice (CRP) was adapted to include diagnostic and therapeutic procedures for patients with Parkinson's disease [1,2]. KDPs are a tool of modern health policy and are intended to assist clinical practitioners in decision-making processes.

It also serves to improve the quality of services provided and the cost-effectiveness of care, and the concept of uniform development of recommended practices has been developed at the national level [3]. The aim of the study was to examine the awareness and use of KDP by clinical practitioners (physicians and non-physician health professionals).

 

Material and methodology

The questionnaire survey was carried out during June and July 2023 by sharing it on the website of the Czech Neurological Society (CNS) and on the website of the Extrapyramidal Section of the CNS in electronic form. A self-constructed questionnaire was used and all data collected were processed in an anonymized form. The sociodemographic data of the respondents (sex, age, highest educational level, job title, length of experience, type of care) and specific items assessing the quality and usefulness of the KDP in clinical practice were monitored in detail. Data were analyzed using descriptive analysis followed by statistical analysis using chi-square test (a = 0.05).

 

Results

A total of 51 respondents (30 women and 21 men) with an average age of 43 years participated in the survey. The study population consisted of 31 physicians, i.e. 61% (12 from outpatient care and 19 from inpatient care), and 20 general nurses, i.e. 39% (11 from outpatient care and 9 from inpatient care), with an average length of clinical experience of 15.2 years. In total, 54.9% of respondents were involved in inpatient settings (n = 28) and 45.1% in ambulatory care (n = 23). Department management was reported by 28 (54.9%) respondents as the primary source of familiarity with the KDP. This was followed by the CNA (33.3%) and the Extrapyramidal Section of the CNA (11.8%) as sources of information.

No general nurses reported using the full KDP compared to physicians, where six reported using the KDP (p = 0.036). The association with educational attainment and length of clinical experience was tested for these six physicians and no statistically significant differences were found. A total of 45 professionals participating in the survey responded that they did not use KDP and did not continue the survey.

A total of 11.8% of the professionals (six physicians) declaring that they use KDPs stated that the recommendations in the KDPs are in line with clinical practice at their workplace, but primarily follow the guidelines of the professional society (n = 1) or the results from clinical trials (n = 5) in the provision of care. Respondents commented on the uniform methodological development of KDPs according to GRADE (The Grading of Recommendations, Assessment, Development and Evaluation), for which five respondents agreed that it was not important. One respondent stated that it was only partially important. Subsequently, respondents commented on the quality of each chapter of the KDP, which they rated using a Likert scale from 1 to 5, with 5 being the highest quality. The summary results are presented in Table 1.

In the context of other proposals for updating the KDP, the addition of new medicines (n = 5) and a comprehensive elaboration of information for patients (n = 2) were recommended.

 

Discussion

Parkinson's disease represents a significant economic burden on health and social systems and a reduction in quality of life for patients as the disease progresses [4]. The KDP at the national level aims to reduce geographical, demographic and other heterogeneities in patient access. During the implementation of the project, it was declared to regularly update the KDP for the diagnosis and treatment of Parkinson's disease according to the needs of the Extrapyramidal Section of the CNN. The recommended practices are now centrally registered in the National Institute for Quality and Excellence in Health Care and, at the request of professional societies, it is possible to update existing recommended practices (NIKEZ) or to develop new recommendations [5]. Approved recommended practices are included in the Journal of the Ministry of Health of the Czech Republic.

The evaluated KDP for patients with Parkinson's disease has the same diagnostic and therapeutic recommendations that are presented in the evaluated KDP for other neurological diagnoses, therefore, a general awareness is necessary also with regard to comorbidities of patients with Parkinson's disease. The study was conducted to verify the degree of applicability of a specific recommended procedure that comprehensively focuses on the diagnosis and treatment of Parkinson's disease, and although this recommended procedure was presented at professional events, only six physicians (11.8%) out of 51 respondents reported its use. The KDP was created following endorsement by a professional society, so it is assumed that if one respondent indicated that they primarily follow the recommendations of a professional society and the results of clinical trials in their practice, the KDP should be the primary source of information. Overall, the elaborated guideline was rated high in quality for the individual care domains, but consistent guideline development according to GRADE was not rated as important for clinical practitioners.

In the context of the new authorised medicines on the market and the evidence from the studies carried out, an update is necessary as some recommendations are no longer in line with reality. At the same time, it is also necessary to provide comprehensive information for patients in lay language. Following the results of the survey, steps will be taken to implement the KDP more effectively, including a greater focus on outpatient care. At the same time, the aim is to increase the use of the KDP by all clinical practitioners and by patients and carers.

 

Limits of the study

From the study we have presented, it is not possible to draw firm conclusions regarding the use and availability of KDP with respect to the number of respondents. Interest in completing the questionnaire was relatively low, although both Parkinson's care centres and outpatient providers were approached. We anticipate that the survey may have generated further interest in the issue.

 

Conclusion

The Clinical Guideline for the Diagnosis and Treatment of Parkinson's Disease is intended to assist healthcare professionals and patients in making healthcare decisions for specific clinical conditions. Evidence-based recommendations may not be appropriate for use in all situations, but are expected to be applicable to a population of individuals with the same diagnosis. Regular updating of recommended practices is necessary, with the addition of the latest registered drugs and diagnostic and therapeutic procedures. To raise awareness among clinical practitioners, regular presentation of the recommendations at professional conferences and through professional society information channels is appropriate. Further steps will be taken to validate the scientific potential based on the acceptance of the KDP by clinical practitioners, including in the context of the planned update of the KDP.

 

Ethical principles

The study was conducted in accordance with the 1975 Declaration of Helsinki (and its 2004 and 2008 revisions). The study was not subject to ethics committee approval, and informed consent was not required due to the anonymised questionnaire survey.

 

Conflict of interest

The authors declare that they have no conflict of interest in relation to the subject of the study.

 

Focus of the chapter	Rating
	1	2	3	4	5
Background -⁠ epidemiological analysis	0	0	5	0	1
Recommendations for communication	0	0	0	0	6
Recommendations for diagnosis and prognosis	0	0	0	0	6
Recommendations for the treatment of motor symptoms	0	0	0	0	6
Recommendations for the treatment of non-motor symptoms	0	0	0	0	6
Recommendations for palliative care	0	0	0	0	6
Information for patients	0	0	0	0	6

 

Table 1: Quality assessment of the individual chapters of the recommended approach.

Focus of the chapter	Rating
	1	2	3	4	5
Background -⁠ epidemiological analysis	0	0	5	0	1
Recommendations for communication	0	0	0	0	6
Recommendations for diagnosis and prognosis	0	0	0	0	6
Recommendations for the treatment of motor symptoms	0	0	0	0	6
Recommendations for the treatment of non-motor symptoms	0	0	0	0	6
Recommendations for palliative care	0	0	0	0	6
Information for patients	0	0	0	0	6
Focus of the chapter	Rating
	1	2	3	4	5
Background -⁠ epidemiological analysis	0	0	5	0	1
Recommendations for communication	0	0	0	0	6
Recommendations for diagnosis and prognosis	0	0	0	0	6
Recommendations for the treatment of motor symptoms	0	0	0	0	6
Recommendations for the treatment of non-motor symptoms	0	0	0	0	6
Recommendations for palliative care	0	0	0	0	6
Information for patients	0	0	0	0	6

Note: the numbers in the chapter ratings indicate the number of individuals who marked the value.