Self-Reported Nonadherence Predicts Changes of Medication after Discharge from Hospital in People with Parkinson's Disease.

Abstract

Background: Medication is often changed after hospital discharge in people with Parkinson's disease (PD).

Objective: This observational study aimed to describe changes in PD medication after discharge and explore their association with self-reported adherence and clinical parameters.

Methods: During hospitalisation sociodemographic characteristics, the Movement Disorder Society-sponsored revision of the Unified PD Rating Scale for motor function (MDS-UPDRS III), Hoehn and Yahr (H&Y) stage, levodopa equivalent daily dose (LEDD), Beck Depression Inventory II (BDI-II) score, Montreal Cognitive Assessment (MoCA) score, nonmotor symptoms questionnaire (NMSQ), and Stendal Adherence to Medication Score (SAMS) were collected in 125 people with PD. A semistructured interview was conducted 1 month after discharge to determine the extent and reasons for medication changes.

Results: Thirty-eight patients (30.4%) changed their PD medication after discharge. Most changes (20.8%) were performed by physicians while 9.6% of patients changed their medication by themselves due to side effects, missing effect of the medication, missing knowledge about the indication, running out of medication, or nonspecific reason. This led to decreased doses while changes by physicians resulted in both increase and decrease of doses as well as new drug prescription. Patients without changes, patients with changes performed by them, and patients with changes performed by physicians did not differ in age, disease duration, MDS-UPDRS III, LEDD, NMSQ, MoCA, BDI-II, gender, marital status, or education. However, patients who themselves made the changes were more likely to be nonadherent according to baseline SAMS. Patients who made changes after discharge had higher SAMS modification and forgetting subscores than patients without changes or with changes made by physicians.

Conclusion: Both intended and unintended nonadherence occur in patients who change medication after discharge. The use of an adherence questionnaire during inpatient treatment may help detect patients with higher risk of changing medication after discharge.