Self-Management Toolkit Cuts Hospital Costs for Parkinson's

TOPLINEA facilitated self-management toolkit for people with Parkinson's disease (PD) improved motor and non-motor experiences of daily living and reduced total health and social care costs by more than £1200 per patient over 12 months, primarily through fewer unplanned hospital admissions.METHODOLOGYA two-arm superiority randomized controlled trial in England recruited 346 community-dwelling adults with PD between January 2022 and July 2023 and randomly assigned 166 to receive the UCL Live Well with Parkinson's intervention and 180 to treatment as usual.Participants had a mean age of 69.1 years, 54% men, and 92.8% were White; most had mild (52.5%) to moderate (44.9%) disease severity based on Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) parts I and II scores.The intervention consisted of a digital or paper self-management toolkit with 64 information sections on PD symptoms, treatments, well-being, and practical advice with up to 6 sessions over 6 months with trained facilitators who supported goal-setting, action planning, and problem-solving.Primary outcome was the 39-item Parkinson's Disease Questionnaire (PDQ-39) score at 12 months; secondary outcomes included non-motor and motor experiences of daily living (MDS-UPDRS parts I and II), utility tariffs, and total health and social care costs over 12 months.Analysis was by intention to treat, with 12-month follow-up assessments available in 141 participants in the intervention group and 164 in the treatment as usual group.TAKEAWAYThe mean PDQ-39 scores were not significantly different between the intervention and the treatment as usual groups.The combined MDS-UPDRS part I and II score improved significantly in the intervention group compared with the treatment as usual group at 12 months (mean difference, -2.61; 95% CI, -4.58 to -0.64), indicating better motor and non-motor experiences of daily living.Non-motor symptoms improved in the intervention group at 6 months (mean difference, -13.22; 95% CI, -23.63 to -2.81), with significant improvements in subdomain for depression at both 6 months and 12 months.Total health and social care costs over 12 months were £1282 lower in the intervention group compared with the treatment as usual group (95% CI, -£2700 to -£118), driven mainly by reduced unplanned hospital admissions, planned hospital admissions, and home adaptations.IN PRACTICE"The online UCL Live Well with Parkinson's self-management intervention could support these ambitions by enabling people with Parkinson's and carers to identify problems they may be experiencing, take more control of their disease, and support symptom management," the authors of the study wrote.SOURCEThe study was led by Anette Schrag, Department of Clinical and Movement Neurosciences, University College London, London. It was published online on July 21 in The Lancet Regional Health - Europe.LIMITATIONSThe study predominantly recruited people with mild-to-moderate PD and excluded those with severe cognitive impairment, limiting applicability to advanced disease. Remote administration of outcome measures may have influenced results compared with standard self-completion formats. The heterogeneity of participant, disease, and treatment characteristics in this real-world approach may have diluted the intervention's true effect.DISCLOSURESThe study was supported by grants from the National Institute for Health and Care Research (NIHR). Three of the authors reported receiving research funding from NIHR programmes and other sources, serving on NIHR advisory boards, and/or receiving honoraria for consultancy from several companies or organizations.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.