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CME / ABIM MOC / CE

New Action Steps to Address Health Disparities in Parkinson's Disease

  • Authors: News Author: Fran Lowry; CME Author: Laurie Barclay, MD
  • CME / ABIM MOC / CE Released: 11/4/2022
  • Valid for credit through: 11/4/2023
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)

    Physician Assistant - 0.25 AAPA hour(s) of Category I credit

    IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for neurologists, internists, family medicine/primary care clinicians, psychiatrists, public health and prevention officials, nurses/nurse practitioners, pharmacists, physician assistants, geriatricians, and other members of the health care team for patients with Parkinson's disease.

The goal of this activity is for learners, members of the healthcare team to be better able to describe 6 avenues for action regarding health disparities in Parkinson's disease, particularly in low- to middle-income countries and resource-limited settings, based on a "Special Communication" published in JAMA Neurology, reporting on a World Health Organization multidisciplinary, sex-balanced, international consultation workshop on global disparities in Parkinson's disease, held April 2021.

Upon completion of this activity, participants will:

  • Evaluate 3 action steps regarding Parkinson's disease burden, advocacy and awareness, and prevention and risk reduction, based on a World Health Organization consultation workshop
  • Assess 3 additional action steps regarding Parkinson's disease diagnosis, treatment, and care; caregiver support; and research, based on a World Health Organization consultation workshop
  • Outline implications for the healthcare team


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


News Author

  • Fran Lowry

    Freelance writer, Medscape

    Disclosures

    Fran Lowry has no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Laurie Barclay, MD, has the following relevant financial relationships:
    Formerly owned stocks in: AbbVie Inc.

Editor/Compliance Reviewer

  • Lisa Simani, APRN, MS, ACNP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Lisa Simani, APRN, MS, ACNP, has no relevant financial relationships.

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.

Peer Reviewer:

This activity has been peer reviewed and the reviewer has no relevant financial relationships.


Accreditation Statements



In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

This activity was planned by and for the healthcare team, and learners will receive 0.25 Interprofessional Continuing Education (IPCE) credit for learning and change.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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    For Nurses

  • Awarded 0.25 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.00 contact hours are in the area of pharmacology.

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    For Pharmacists

  • Medscape designates this continuing education activity for 0.25 contact hour(s) (0.025 CEUs) (Universal Activity Number: JA0007105-0000-22-340-H01-P).

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  • For Physician Assistants

    Medscape, LLC has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.25 AAPA Category 1 CME credits. Approval is valid until 11/4/2023. PAs should only claim credit commensurate with the extent of their participation.

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

CME / ABIM MOC / CE

New Action Steps to Address Health Disparities in Parkinson's Disease

Authors: News Author: Fran Lowry; CME Author: Laurie Barclay, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 11/4/2022

Valid for credit through: 11/4/2023

processing....

Clinical Context

The rise in PD cases, disability, and deaths is likely multifactorial and affected by aging populations; better research methods, technologies, and education; increased disease awareness; longer life expectancy; and specific environmental exposures. Available treatment resources are grossly insufficient, with large disparities across regions, income levels, and countries.

Motor and nonmotor manifestations of PD include mental health disorders, impaired mobility, sleep disturbance, mood and cognition issues, autonomic dysfunction, and markedly decreased quality of life for patients and their caregivers. Because of large inequalities in access to neurological care across different world regions, vulnerable populations often bear a higher disease burden and stigma.

Study Synopsis and Perspective

A World Health Organization (WHO) consultation workshop on global disparities in Parkinson's disease (PD) has suggested 6 avenues for action to address the needs of these patients.

Current estimates suggest that PD resulted in 5.8 million disability-adjusted life-years (DALYs) increasing by 81% since 2000. In addition, it's estimated that PD caused 329,000 deaths in 2019 and increased more than 100% globally since 2000. Moreover, many patients affected by PD live in low- and middle-income countries and experience large inequalities in access to neurologic care and essential medicines.

To address these issues, the Brain Health Unit at the WHO developed 6 "action steps" that it says are urgently required to combat global disparities in PD.

The need for action is great, lead author Nicoline Schiess, MD, MPH, a neurologist and technical officer in the WHO's Brain Health Unit in Geneva, Switzerland, told Medscape Medical News.

"In adults, disorders of the nervous system are the leading cause of disability-adjusted life-years, or DALYs, and the second leading cause of death globally, accounting for 9 million deaths per year," Dr Schiess said.

The WHO's recommendations were published online recently as a "Special Communication" in JAMA Neurology.

Serious Public Health Challenge

PD is the fastest growing disorder in terms of death and disability, and it is estimated that it caused 329,000 deaths in 2019, for an increase of more than 100% since 2000.

"The rise in cases is thought to be multifactorial and is likely affected by factors such as aging populations and environmental exposures, such as certain pesticides. With these rapidly increasing numbers, compounded by a lack of specialists and medicines in low- and middle-income countries, PD presents a serious public health challenge," Dr Schiess said.

The publication of the 6 action steps is targeted toward clinicians and researchers who work in PD, she added. The steps address the following areas:

  1. Disease burden
  2. Advocacy and awareness
  3. Prevention and risk reduction
  4. Diagnosis, treatment, and care
  5. Caregiver support
  6. Research

Dr Schiess noted that data on disease burden are lacking in certain areas of the world, such as low- and middle-income countries, and information "based on race and ethnicity are inconsistent. Studies are needed to establish more representative epidemiological data."

She said that advocacy and awareness are particularly important because young people may not be aware they can also develop PD, and sex and race differences can factor in to the potential for delays in diagnosis and care. "This is often due to the incorrect perception that PD only affects older people," she noted.

In addition, "a substantial need exists to identify risks for PD--in particular, the risks we can mitigate," said Dr Schiess, citing pesticide exposure as one example. "The evidence linking pesticide exposure--for example, paraquat and chlorpyrifos--with the risk of developing PD is substantial. And yet in many countries, these products are still being used."

Under the heading of diagnosis, treatment, and care, Dr Schiess noted that patients with PD in "low-resource settings" and low-to-middle income countries are unable to obtain "even the most basic medications" to treat PD.

"Strengthening health and social systems, and building capacity to improve medical care, including rehabilitation and palliative care and medication access, are vital. Also, education and training of primary healthcare professionals, growing the neurological workforce, and increasing the use of digital technology such as telemedicine, are key mechanisms to improving diagnosis and sustainability of care," she said.

For caregiver support, Dr Schiess pointed out that the progressive nature of the disease and timing of onset are contributors to increased caregiver burden. Other contributors, as the disease advances in a patient, include the development of cognitive impairment, psychiatric manifestations, and sleep disruption.

"Solutions that could decrease the burden on caregivers includes providing an accurate and timely diagnosis and training and education to caregivers, such as the WHO iSUPPORT program, as well as psychosocial, financial, and community-based support," said Dr Schiess.

For research, she noted that the number of studies in the field of PD has grown because of increased funding and a greater number of initiatives during the past 2 decades.

"Continuing to build on this momentum is important in order to generate new treatment options, better care, and research capacity, especially in low- and middle-income countries," she said.

Dr Schiess emphasized the urgency for adopting these measures as cases of PD continue to rise.

"The take-away message for clinicians is that [PD] is a growing global public health issue and there is a pressing need for a global public health response to address health and social requirements for people with PD," she said.

Dr Schiess reports having received grants from the Edmond J. Safra Foundation paid to her institution during the conduct of the study.

JAMA Neurol. Published online July 11, 2022.[1]

Study Highlights

  • The 6 action steps address disease burden; advocacy and awareness; prevention and risk reduction; diagnosis, treatment, and care; caregiver support; and research.
  • The disease burden of PD is significant: it is the fastest growing disease cause of death and disability, with an estimated 329,000 deaths in 2019 (>100% increase since 2000).
  • Reasons underlying increased PD burden include aging populations, pesticides, and other environmental exposures.
  • Data on disease burden are lacking in low- and middle-income countries and certain world regions and are inconsistent regarding racial/ethnic disparities, mandating further research.
  • Advocacy and awareness interventions are needed as young people may be unaware that they can develop PD, sex and race differences may potentially delay diagnosis and care, and products known to increase PD risks, such as paraquat and chlorpyrifos pesticides, are still in use in many countries.
  • Prevention and risk reduction should include mitigating modifiable risks for PD.
  • Amphetamine/methamphetamine use, lack of physical activity, heavy metal exposure, air pollution, traumatic brain injury, and industrial solvents including trichloroethylene may increase PD risk but need further study.
  • PD risk from exposure to pesticides or other toxins is not limited to those with occupational exposure but is also increased for those in the immediate vicinity of farmlands and rural communities.
  • Protective factors for PD that are potentially useful in secondary prevention include caffeine, physical activity, and possibly uric acid.
  • Effective preventive actions to slow or stop rising PD incidence are needed before treatment costs overwhelm country health services.
  • PD diagnosis, treatment, and care are hindered in low-resource settings and low- and middle-income countries, where specialists and even basic medications are often unavailable.
  • Strengthening health and social systems, and building capacity to improve rehabilitation, palliative care, medication access, and other medical care, are therefore vital.
  • Improving diagnosis and sustainability of care requires education and training of primary clinicians, increasing the neurological workforce, and improving access to telemedicine and other digital technology.
  • Barriers to an integrated system of interdisciplinary PD care, particularly in low-resource settings, include lack of prevention, awareness, services, therapies, treatments, and care.
  • Caregiver support is needed, given the increased burden imposed by the progressive course of PD and development of cognitive impairment, psychiatric symptoms, and sleep disruption.
  • Interventions to reduce caregiver burden include accurate, timely PD diagnosis; caregiver training and education via the WHO iSUPPORT program or similar interventions; and psychosocial, financial, and community-based support.
  • PD research has increased during the past 20 years because of more funding and initiatives, but this momentum must continue to develop new and better treatment and care options, especially in low- and middle-income countries.
  • PD is a growing global public health issue, which mandates a collaborative global public health response by governments, multilateral agencies, donors, public health organizations, and clinicians to address health and social requirements for people with PD, their families, and their caregivers.

Clinical Implications

  • PD is a growing global public health issue mandating a collaborative global public health response.
  • PD diagnosis, treatment, and care are hindered in low-resource settings and low- and middle-income countries, where specialists and even basic medications are often unavailable.
  • Implications for the Health Care Team: Improving diagnosis and sustainability of care require education and training of the healthcare team.

 

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