Objective: To examine allied health care (AHC) utilization in older adults with Parkinson’s disease in the United States.

Background: Multiple studies have demonstrated the efficacy of physical, occupational and speech therapy (collectively known as allied health care) in Parkinson’s disease (PD) and AAN quality guidelines advocate for regular assessment of the need for these therapies. No study to date has examined allied health care utilization for PD in the US.

Methods: In this cross-sectional study of Medicare beneficiaries with Parkinson’s disease, receipt of physical therapy (PT), occupational therapy (OT) or speech therapy (ST) was identified using billing claims from 2007 to 2009. Only individuals with at least 12 months of Medicare data were included. To examine the impact of increasing physician visit frequency on AHC utilization, all outpatient neurologist visits were extracted.

Results: A total of 742,846 Medicare beneficiaries who met the inclusion and exclusion criteria were identified. Of these PD patients, only 11.1% had claims for PT/OT and 11.5% for ST. Asian Americans were the highest users of PT/OT (10.3%) and ST (16.6%), followed by whites (PT/OT: 7.5%, ST: 11.7%). African Americans had the lowest utilization percentage for all AHC at 3.7% and 6.5%. Regression models support the finding of racial disparities in AHC with an adjusted OR for African Americans of 0.67 (0.64-0.70). In the cohort, only 31% of PD patients received neurologist care in a given year. Patients with at least one neurologist visit per year were 50% more likely to receive an evaluation for PT than those without neurologist care (AOR: 1.50, 1.47-1.53). This relationship was similar for OT evaluation (AOR: 1.48, 1.41-1.55), PT/OT (AOR: 1.31, 1.29-1.33), and ST (AOR: 1.52, 1.50-1.55). There were incremental increases in the odds of receiving AHC by levels of neurologist participation in PD care. For patients with more than three neurologist visits, the odds of ST evaluation was the highest (AOR: 1.80, 1.76-1.84), followed by OT evaluation (AOR: 1.78, 1.67-1.89), and PT evaluation (AOR: 1.73, 1.68-1.77).

Conclusions: Allied health care is highly underutilized among US Medicare beneficiaries with PD. Neurologist care is associated with increased use. Further studies are needed to identify barriers to guideline adherent care in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/underutilization-of-physiotherapy-for-parkinsons-disease-in-the-united-states/