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Parkinson’s disease: diagnosis and management in primary and secondary care [CG35]

Measuring the use of this guidance

Recommendation: 1.1.1.3

Because people with PD may develop impaired cognitive ability, a communication deficit and/or depression, they should be provided with: • both oral and written communication throughout the course of the disease, which should be individually tailored and reinforced as necessary • consistent communication from the professionals involved

What was measured: Proportion of Parkinson's clinics that had written information about Parkinson’s and Parkinson’s medication routinely available all or most of the time.
Data collection end: September 2015
82.4%
Area covered: National
Source: UK Parkinson's Audit

What was measured: Proportion of people with Parkinson’s disease who received enough information about Parkinson’s on diagnosis.
Data collection end: September 2015
64.9%
Area covered: National
Source: UK Parkinson's Audit


Recommendation: 1.1.1.6

People with PD should be offered an accessible point of contact with specialist services. This could be provided by a Parkinson’s disease nurse specialist

What was measured: Proportion of people with Parkinson's disease who had access to a Parkinson’s nurse in Elderly Care and Neurology services.
Data collection end: September 2015
94.1%
Area covered: National
Source: UK Parkinson's Audit


Recommendation: 1.1.1.7

All people with PD who drive should be advised to inform the Driver and Vehicle Licensing Agency (DVLA) and their car insurer of their condition at the time of diagnosis.

What was measured: Proportion of drivers with Parkinson's disease given verbal and/or written advice about contacting the DVLA (or DVA) and car insurance company.
Data collection end: September 2015
73.4%
Area covered: National
Source: UK Parkinson's Audit


Recommendation: 1.2.4.1

The diagnosis of PD should be reviewed regularly and re-considered if atypical clinical features develop.

What was measured: Proportion of PD patients under neurologists who have had medical review within last year
Data collection end: September 2015
98.3%
Area covered: National
Source: UK Parkinson's Audit

What was measured: Proportion of PD patients under elderly care team who have had medical review within last year.
Data collection end: September 2015
98.9%
Area covered: National
Source: UK Parkinson's Audit


Recommendation: 1.6.1.4

Clinicians should be aware of dopamine dysregulation syndrome, an uncommon disorder in which dopaminergic medication misuse is associated with abnormal behaviours, including hypersexuality, pathological gambling and stereotypic motor acts. This syndrome may be difficult to manage

What was measured: Proportion of people with Parkinson's disease who are taking dopamine agonists, with evidence recorded that they are monitored for compulsive behaviours.
Data collection end: September 2015
77.5%
Area covered: National
Source: UK Parkinson's Audit


Recommendation: 1.8.2.4

People with PD who have sudden onset of sleep should be advised not to drive and to consider any occupational hazards. Attempts should be made to adjust their medication to reduce its occurrence

What was measured: Proportion of people with Parkinson's disease who are drivers, that had a documented discussion of the impact of known excessive daytime sleepiness on driving.
Data collection end: September 2015
56.5%
Area covered: National
Source: UK Parkinson's Audit


Recommendation: 1.9.2.1

Physiotherapy should be available for people with PD. Particular consideration should be given to: • gait re-education, improvement of balance and flexibility • enhancement of aerobic capacity • improvement of movement initiation • improvement of functional independence, including mobility and activities of daily living • provision of advice regarding safety in the home environment

What was measured: Proportion of people with Parkinson's disease whose time between diagnosis and physiotherapy referral was less than 1 year.
Data collection end: September 2015
27%
Area covered: National
Source: UK Parkinson's Audit


Recommendation: 1.9.3.1

Occupational therapy should be available for people with PD. Particular consideration should be given to: • maintenance of work and family roles, home care and leisure activities • improvement and maintenance of transfers and mobility • improvement of personal self-care activities, such as eating, drinking, washing and dressing • environmental issues to improve safety and motor function • cognitive assessment and appropriate intervention.

What was measured: Proportion of people with Parkinson's disease referred to occupational therapy at an appropriate time according to the occupational therapist.
Data collection end: September 2015
89.4%
Area covered: National
Source: UK Parkinson's Audit


Recommendation: 1.9.4.1

Speech and language therapy should be available for people with PD. Particular consideration should be given to: • improvement of vocal loudness and pitch range, including speech therapy programmes such as Lee Silverman Voice Treatment (LSVT) • teaching strategies to optimise speech intelligibility • ensuring an effective means of communication is maintained throughout the course of the disease, including use of assistive technologies • review and management to support safety and efficiency of swallowing and to minimise the risk of aspiration.

What was measured: Proportion of people with Parkinson's disease whose target time is met between referral and first speech and language therapy appointment.
Data collection end: September 2015
85.4%
Area covered: National
Source: UK Parkinson's Audit


Recommendation: 1.10.1.1

Palliative care requirements of people with PD should be considered throughout all phases of the disease

What was measured: The proportion of people with markers of advanced Parkinson's disease who had a documented discussion about end-of-life care issues/care plans.
Data collection end: September 2015
28%
Area covered: National
Source: UK Parkinson's Audit

What was measured: Evidence the patient or carer has been offered information about, or has set up, a lasting power of attorney or power of attorney in Scotland (where there are markers of advanced disease)
Data collection end: September 2015
26.3%
Area covered: National
Source: UK Parkinson's Audit



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