Abstract
Objective: To examine rehabilitation therapy utilization for Parkinson disease (PD). Methods: We identified 174,643 Medicare beneficiaries with a diagnosis of PD in 2007 and followed them through 2009. The main outcome measures were annual receipt of physical therapy (PT), occupational therapy (OT), or speech therapy (ST). Results: Outpatient rehabilitation fee-for-service use was low. In 2007, only 14.2% of individuals with PD had claims for PT or OT, and 14.6% for ST. Asian Americans were the highest users of PT/OT (18.4%) and ST (18.4%), followed by Caucasians (PT/OT 14.4%, ST 14.8%). African Americans had the lowest utilization (PT/OT 7.8%, ST 8.2%). Using logistic regression models that accounted for repeated measures, we found that African American patients (adjusted odds ratio [AOR] 0.63 for PT/OT, AOR 0.63 for ST) and Hispanic patients (AOR 0.97 for PT/OT, AOR 0.91 for ST) were less likely to have received therapies compared to Caucasian patients. Patients with PD with at least one neurologist visit per year were 43% more likely to have a claim for PT evaluation as compared to patients without neurologist care (AOR 1.43, 1.30-1.48), and this relationship was similar for OT evaluation, PT/OT treatment, and ST. Geographically, Western states had the greatest use of rehabilitation therapies, but provider supply did not correlate with utilization. Conclusions: This claims-based analysis suggests that rehabilitation therapy utilization among older patients with PD in the United States is lower than reported for countries with comparable health care infrastructure. Neurologist care is associated with rehabilitation therapy use; provider supply is not.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1162-1169 |
| Number of pages | 8 |
| Journal | Neurology |
| Volume | 89 |
| Issue number | 11 |
| DOIs | |
| State | Published - Sep 1 2017 |
Funding
M. Fullard is funded by NIH training grant T32NS061779-07. D. Thibault, A. Hill, and J. Fox report no disclosures relevant to the manuscript. D. Bhatti is on a speaker panel for Teva Neurosciences and ACCADIA Pharmaceuticals. A. Burack reports no disclosures relevant to the manuscript. N. Dahodwala is funded by the NIH, National Parkinson Foundation, Parkinson Counsil, Biotie, and AbbVie. E. Haberfeld reports no disclosures relevant to the manuscript. D. Kern has served as an advisor for Michael J. Fox Foundation and AbbVie Pharmaceutics; has received honorarium from Merz Pharma, AbbVie Pharmaceutics, and SAI-Med Partners, LLC; and has received grants from the Parkinson’s Society of Canada and University of Colorado Skin Disease Research Center. O. Klepitskaya received consulting fees from Acadia Pharmaceuticals. E. Urrea-Mendoza received honorarium from Great Lakes NeuroTechnol-ogies. P. Myers reports no disclosures relevant to the manuscript. J. Nutt serves as a consultant for Neuroderm Ltd., Merck, Elan Pharmaceuticals, Lundbeck Inc., ONO Pharma, SynAgile Crop., Prexa Inc., and US World Med, and has received honoraria from the American Academy of Neurology. M. Rafferty reports no disclosures relevant to the manuscript. J. Schwalb receives research funding from Medtronic. L. Shulman is funded by the NIH for research and clinical trials, as well as the Fox Foundation, The Veteran’s Administration Medical Center, PCORI, The Rosalyn Newman Foundation, The Brin Family, and Biotie Therapies. A. Willis received research support from the NIH (K23NS081087), the Patient-Centered Outcomes Research Institute (PCORI), the St. Louis Chapter of the American Parkinson Disease Association, the University of Pennsylvania, Walter and Connie Donius, and The Robert Renschen Fund. Go to Neurology.org for full disclosures. This study was funded by NIH K23NS081087 and T32NS061779-07.
ASJC Scopus subject areas
- Clinical Neurology