Current clinical practice for Parkinson’s disease among Chinese physicians, general neurologists and movement disorders specialists: a national survey

BMC Neurology - Tập 12 - Trang 1-9 - 2012
Wei Chen1, Shuai Chen1, Qin Xiao1, Gang Wang1, Sheng-Di Chen1
1Department of Neurology & Institute of Neurology, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

Tóm tắt

To explore current status and choices regarding diagnosis and treatment of Parkinson’s disease (PD) among physicians, general neurologists and movement disorders specialists in China via a national survey. The cross-sectional questionnaire-based survey was conducted from November, 2010 to July, 2011. Six hundreds and twelve doctors from different cities in China were recruited for this study. 68.6% (n=420) and 23.9% (n=146) of doctors have read the national and international guidelines, respectively. There was a larger proportion of movement disorders specialists reading the guidelines, in contrast to physicians and general neurologists (P<0.001). Up to 76.4% (n=465) and 81.8% (n=498) of doctors would choose standard oral levodopa test and conventional MRI(with T1 and T2), respectively; Whereas susceptibility weighed imaging(SWI)(16.1%; n=98), transcranial sonography (TCS) (1.8%; n=11) and functional neuroimaging test, such as single photon emission computed tomography(SPECT) (10.2%; n=62) and positron emission tomography(PET)(13.3%; n=81) were less used for suspected patients with PD in clinical practice. Doctors at different levels or from different hospitals and cities would choose different medication for motor complications and non-motor symptoms of patients with PD, in addition to initial drug selection for newly diagnosed PD. Doctors who had read the guidelines had significantly better knowledge of medication selections for PD under specific circumstances. Compared with commonly employed standard oral levodopa test and conventional MRI, SWI complements MRI, TCS and functional neuroimaging were less performed for diagnosis of PD in clinical practice in China. The choices of diagnostic methods and therapeutic strategy of PD vary among physicians, general neurologists and movement disorders specialists. Guideline awareness is markedly beneficial to reasonable PD medications strategy in China.

Tài liệu tham khảo

Zhang ZX, Roman GC, Hong Z, et al: Parkinson's Disease in China: prevalence in Beijing, Xian, and Shanghai. Lancet. 2005, 365: 595-597. Chen SD: (The Chinese movement disorders and Parkinson’s disease society): The guideline for management of Parkinson’s disease in China. Chin J Neurol. 2006, 39: 409-412. Chen SD: (The Chinese movement disorders and Parkinson’s disease society): The guideline for management of Parkinson’s disease in China (second edition). Chin J Neurol. 2009, 42: 352-355. Miyasaki JM, Shannon K, Voon V, et al: Practice parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review): report of the quality standards subcommittee of the American academy of neurology. Neurology. 2006, 66: 996-1002. 10.1212/01.wnl.0000215428.46057.3d. Pahwa R, Factor SA, Lyons KE, et al: Practice parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): report of the quality standards subcommittee of the American academy of neurology. Neurology. 2006, 66: 983-995. 10.1212/01.wnl.0000215250.82576.87. Suchowersky O, Gronseth G, Perlmutter J, Reich S, Zesiewicz T, Weiner WJ: Practice parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review): report of the quality standards subcommittee of the American academy of neurology. Neurology. 2006, 66: 976-982. 10.1212/01.wnl.0000206363.57955.1b. Suchowersky O, Reich S, Perlmutter J, Zesiewicz T, Gronseth G, Weiner WJ: Practice parameter: diagnosis and prognosis of new onset Parkinson disease (an evidence-based review): report of the quality standards subcommittee of the American academy of neurology. Neurology. 2006, 66: 968-975. 10.1212/01.wnl.0000215437.80053.d0. National Collaborating Centre for Chronic Conditions (UK): Parkinson’s Disease: National clinical guideline for diagnosis and management in primary and secondary care [Internet]. 2006, Available from URL: http://www.nice.org.uk/CG035. Tian YY, Tang CJ, Wu J, Zhou JS: Parkinson's Disease in China. Neurol Sci. 2011, 32: 23-30. Fargel M, Grobe B, Oesterle E, Hastedt C, Rupp M: Treatment of Parkinson's disease: a survey of patients and neurologists. Clin Drug Investig. 2007, 27: 207-218. 10.2165/00044011-200727030-00004. Eggert K, Larisch A, Dodel R, Bormann C, Oertel WH: Awareness and knowledge of the clinical practice guideline on Parkinson's disease among German neurologists. Eur Neurol. 2009, 61: 216-222. 10.1159/000197106. Larisch A, Oertel WH, Eggert K: Attitudes and barriers to clinical practice guidelines in general and to the guideline on Parkinson's disease. A National Survey of German neurologists in private practice. J Neurol. 2009, 256: 1681-1688. 10.1007/s00415-009-5178-3. Willis AW, Schootman M, Evanoff BA, Perlmutter JS, Racette BA: Neurologist care in Parkinson disease: a utilization, outcomes, and survival study. Neurology. 2011, 77: 851-857. 10.1212/WNL.0b013e31822c9123. Guo Y, Shibuya K, Cheng G, Rao K, Lee L, Tang S: Tracking China's health reform. Lancet. 2010, 375: 1056-1058. 10.1016/S0140-6736(10)60397-2. Shi FD, Jia JP: Neurology and neurologic practice in China. Neurology. 2011, 77: 1986-1992. 10.1212/WNL.0b013e31823a0ed3. Wang G, Cheng Q, Zheng R, et al: Economic burden of Parkinson's disease in a developing country: a retrospective cost analysis in Shanghai, China. Mov Disord. 2006, 21: 1439-1443. 10.1002/mds.20999. Wang G, Zhou HY, Zheng R, et al: Investigation on the clinical use of anti-Parkinson’s disease drugs for patients with Parkinson’s disease. J Clin Neurol. 2006, 19: 336-338. Wang XP, Zhang WF, Huang HY, Preter M: Neurology in the People's republic of China–an update. Eur Neurol. 2010, 64: 320-324. 10.1159/000321648. Ross GW, Petrovitch H, Abbott RD, et al: Association of olfactory dysfunction with risk for future Parkinson's disease. Ann Neurol. 2008, 63: 167-173. 10.1002/ana.21291. Iranzo A, Valldeoriola F, Lomena F, et al: Serial dopamine transporter imaging of nigrostriatal function in patients with idiopathic rapid-eye-movement sleep behaviour disorder: a prospective study. Lancet Neurol. 2011, 10: 797-805. 10.1016/S1474-4422(11)70152-1. Abbott RD, Petrovitch H, White LR, et al: Frequency of bowel movements and the future risk of Parkinson's disease. Neurology. 2001, 57: 456-462. 10.1212/WNL.57.3.456. Walter U, Hoeppner J, Prudente-Morrissey L, Horowski S, Herpertz SC, Benecke R: Parkinson's Disease-like midbrain sonography abnormalities are frequent in depressive disorders. Brain. 2007, 130: 1799-1807. 10.1093/brain/awm017. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2377/12/155/prepub