Objective: To assess the use of inappropriate drugs among patients with parkinsonism in primary care. As secondary objectives, we planned to identify those clinical factors associated with the prescription of inappropriate drugs and to analyze the clinical impact in the patients.

Background: The administration of inappropriate drugs in patients with parkinsonism can cause not only a motor worsening but also a global deterioration of these patients. Up to 40% of patients with Parkinson’s Disease (PD) admitted to tertiary hospitals receive inappropriate drugs. There is a lack of information about the prescription of non-recommended drugs in patients with parkinsonism in primary care.

Methods: This is a retrospective study. We included those patients with parkinsonism, followed in our Movement Disorders Unit between 2008 and 2015, of whom we had data from the primary care centers. Demographic and clinical data were recorded.

Results: A total of 328 patients were included. Mean age was 71,1±9,9 years and 190 (57,9%) were men. Most patients (75,3%) had PD, but other diagnosis were observed: atypical parkinsonism (11,9%), drug-induced parkinsonism (3,7%) and vascular parkinsonism (3.7%). The prescription of an inappropriate drug was observed in 126 (38,4%) patients. Among the drugs administrated, the most frequent were: antiemetics (31,9%), vestibular suppressants (20,5%) and neuroleptics (20,5%). Patients that received inappropriate drugs were older (p=0,016), had a predominant female gender (p=0,003), a higher prevalence of dementia (p=0,0006) and psychiatric disease (p=0,031), greater number of active diseases (p<0,001) and a higher number of treatments in the medical prescription (p<0,001). After the multivariate analysis, the prescription of inappropriate drugs was only associated with the number of active diseases (OR=1,05 [1,01-1,21]) and the number of drugs in the medical prescription (OR=1,13 [1.06-1,21]).  Those patients who received inappropriate drugs presented a higher number of referrals to specialists per year (p=0,001), and a greater number of visits to the general practitioner per year (p<0,001).

Conclusions: More than a third of the patients with parkinsonism attended in primary care received inappropriate drugs. The factors related to the prescription of inappropriate drugs were the presence of concomitant diseases and the intake of a higher number of treatments. The administration of contraindicated drugs was associated with more medical visits.

References: (1)Magalinou K et al. Prescribing medications in Parkinson’s disease (PD) patients during acute admissions to a District General Hospital. Parkinsonism Relat Disord 2007.

(2)Gabriel J et al. Assessment of appropiate medication administration for hospitalized patients with Parkinson’s disease.Parkinsonism Relat Disord 2012. 

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