Medication adherence and associated outcomes in medicare health maintenance organization-enrolled older adults with Parkinson's disease.

Maintenance of symptom control in Parkinson's disease (PD) requires continuous titration of medication and addition of multiple therapies over the course of the disease. Adherence to medication is vital to symptom control and key to maximizing the efficacy of existing therapies. However, adherence is compromised by a variety of factors, including motor symptoms, complex dosing regimens, multiple medications, and lack of patient/physician awareness of the impact and prevalence of suboptimal adherence. This retrospective, longitudinal cohort study assessed the prevalence of suboptimal adherence [measured as the medication possession ratio (MPR)] to PD medications, and its impact on the worsening of PD symptoms (measured as increase in monotherapy dose, augmentation of therapy, PD-related emergency department visit, or hospitalization), in a Medicare Health Maintenance Organization population in the United States. Irrespective of the MPR threshold chosen, a high percentage of patients were categorized as suboptimally adherent to their PD medications, and patients with suboptimal adherence to their PD medications had higher risks of worsening of PD symptoms, compared with those who were adherent. Increased awareness of both the magnitude and impact of suboptimal adherence to PD medications, coupled with dosage simplification and a unified effort by healthcare professionals and patients, may improve adherence to PD medications and ultimately improve symptom control.

Predictors of health-related quality of life in sufferers with restless legs syndrome: a multi-national study.

BACKGROUND AND PURPOSE: To explore aspects of restless legs syndrome (RLS) associated with detrimental impact on health-related quality of life (HRQoL). PATIENTS AND METHODS: The RLS epidemiology, symptoms, and treatment (REST) survey included SF-36 data on adults with RLS symptoms in the USA and five European countries. Linear regression models on each SF-36 dimension score explored factors influencing HRQoL in this population. RESULTS: Of 16,202 people surveyed, 7% screened positively for RLS. Severity of RLS symptoms was strongly associated with impaired physical and mental HRQoL in both the cohorts from the USA and Europe. Distress and symptom frequency also had predictive capability. In addition, significantly diminished HRQoL was associated with the use of prescription medication for RLS symptoms. Age, number of comorbidities, and number of physician visits were statistically associated with lower HRQoL in respondents with RLS. CONCLUSIONS: Diminished HRQoL was partly accounted for by a number of RLS-related factors, including frequency, severity, and distress from symptoms. The negative impact of prescription medications on HRQoL, in contrast to demonstrated improvements with dopamine agonists, suggests inappropriate or ineffective medications are being used in this population. Our results strongly support the need for better physician education, both to diagnose the condition and importantly provide appropriate treatment with dopamine agonists, the only class of medication, that has been shown to improve the HRQoL of patients with RLS.

Evaluating the quality of life of patients with restless legs syndrome.

BACKGROUND: The primary morbidities of restless legs syndrome (RLS) involve sleep loss, extreme discomfort, and disruption of normal activities. Although the condition is not life-threatening, assessing the disease burden and the impact of RLS on quality of life (QOL) is critical for evaluating treatment benefits. OBJECTIVE: The purpose of this study was to assess the impact of RLS on QOL. METHODS: In this subanalysis of a specific validation study, the SF-36 (Medical Outcomes Study 36-Item Short Form health survey) was administered to 85 patients with primary RLS who had been referred to a sleep-medicine clinic. The scores were compared with published norms for the general population (N = 2474). RESULTS: The majority (63.5%) of RLS patients were women; the mean (SD) age was 62.4 (14.0) years; 67.1% of patients experienced RLS symptoms almost daily. The RLS group, particularly patients with more severe RLS, reported significant deficits (10-40 points on 100-points scales) in physical functioning, bodily pain, role functioning, mental health, general health, and vitality compared with the general population. The RLS sample had significantly lower scores (worse QOL) on all 8 scales of the SF-36 compared with patients with hypertension (P<0.01); compared with patients with other cardiovascular conditions (ie, congestive heart failure, myocardial infarction within the past year, and angina), the RLS group had lower scores on 6 of the 8 scales. RLS patients had lower scores on 7 of 8 scales compared with diabetes patients, and on 4 of 8 scales compared with osteoarthritis patients. CONCLUSIONS: Comparison of the SF-36 scores of patients with RLS and the normative general population suggests that the disorder has a significant impact on patient QOL.

Cost-effectiveness of gemifloxacin: results from the GLOBE study.

The cost-effectiveness of treatment with oral gemifloxacin versus oral clarithromycin for acute exacerbations of chronic bronchitis (AECB) was evaluated. Economic outcomes were assessed for the Gemifloxacin Long-term Outcomes in Bronchitis Exacerbations study. This prospective double-blind, controlled, health outcomes study compared health, economic, and clinical outcomes after randomized treatment with either oral gemifloxacin or oral clarithromycin for AECB. Base case analysis was performed from the third-party payer's perspective and considered the costs of respiratory tract infection-related medical care. Analysis from the societal perspective also included costs of lost productivity. Treatment effectiveness was measured as the proportion of patients without recurrence requiring antimicrobial treatment following resolution of the initial AECB. Data sources included the outcomes study itself and standard U.S. cost sources. Compared with clarithromycin, gemifloxacin treatment resulted in significantly more patients without AECB recurrence requiring antimicrobial treatment after 26 weeks (73.8% versus 63.8%, p = 0.024). Fewer patients receiving gemifloxacin were hospitalized (5 of 214 patients versus 14 of 224 patients, p = 0.059), and they had less time off from usual activities (8.3 days versus 10.1 days). The mean direct cost per patient receiving gemifloxacin was $127 less than with clarithromycin ($247 versus $374, respectively); mean total costs (direct plus indirect) per patient were $329 less for patients receiving gemifloxacin ($1413 versus $1742). Gemifloxacin dominated clarithromycin in cost-effectiveness analysis. Bootstrap analysis indicated that the probability of gemifloxacin being both cost saving and more effective than clarithromycin is 88% from a payer's perspective and 84% from the societal perspective. Gemifloxacin was more cost-effective, improving AECB outcomes and producing substantial cost offsets compared with clarithromycin.

Validation of the Restless Legs Syndrome Quality of Life questionnaire.

OBJECTIVES: The Restless Legs Syndrome Quality of Life questionnaire (RLSQoL) assesses the impact of RLS on daily life, emotional well-being, social life, and work life. This study investigates its validity and reliability. METHODS: The RLSQoL was tested in 85 American adults with primary RLS. Patients were also asked to rate symptom severity with the International Restless Legs Scale (patient-reported version) and report on changes in symptoms over the 2-week period. RESULTS: The RLSQoL summary scale score (range: 0-100) demonstrated acceptable internal consistency reliability (Cronbach's alpha = 0.92) and test-retest reliability (intraclass correlation coefficient = 0.84). All items indicated acceptable item-convergent validity. The RLSQoL distinguished between groups with mild, moderate, and severe symptoms (F = 52.22, P < 0.0001). It demonstrated preliminary responsiveness to changes in RLS status over 2 weeks (effect size: improvement, 0.25; deterioration, -0.32), indicating moderate scale changes consistent with the small clinical change over this time. CONCLUSIONS: These findings support the conceptual framework of the RLSQoL. It is a valid and reliable measure of the impact of RLS on QoL and is responsive to short-term changes in symptom severity. The RLSQoL appears to be an appropriate tool for trial-based assessments of treatments for RLS.