Advanced Practice Providers Recognize and Consider the Impact of On-Demand Therapy in Parkinson Disease


In a recent survey, a group of advanced practice providers recognized the importance and considered the emotional impact of the unexpected return of symptoms on the life of a patient with Parkinson disease.

Kelly Papesh, DNP-C, MSN, executive director of the newly launched Association of Movement Disorder Advanced Practice Providers (AMDAPP)

Kelly Papesh, DNP-C, MSN

In a recent survey of neurology advanced practice providers (APPs), all recognized the emotional impact of OFF periods and considered their impact on patient's social when choosing an on-demand therapy prescription.1 This survey provided insights into the APPs’ perspectives for managing and treating patients with Parkinson disease (PD) in the US healthcare industry, emphasizing the use of on-demand therapy.

On average, 43% of residents believed patients might benefit from the use of on-demand therapy (believed, 22%; would benefit, at least 61%) with patients benefitting the most from improved control over their symptoms. However, only 38% of the respondents always considered the emotional impact of OFF periods when evaluating a patient for on-demand therapy and only 28% frequently prescribed them.

”This discrepancy represents a disconnect between respondents' views of the high importance of the emotional impact of OFF periods on patients when considering prescribing on-demand therapy and the low relative importance ascribed to the emotional impact of OFF when respondents considered the factors they use to evaluate a candidate for on-demand therapy,” lead author Kelly Papesh, DNP-C, MSN, and colleagues wrote.1

The findings were presented by Papesh, executive director of the newly launched Association of Movement Disorder Advanced Practice Providers (AMDAPP), at the 2nd Annual Advanced Therapeutics in Movement and Related Disorders (ATMRD) Congress, held by the PMD Alliance from June 8 to 11, 2023, in Washington, DC. Papesh and colleagues aimed to better understand the role nurses and assistants played in managing PD and to learn about their experiences in prescribing on-demand therapy and treating PD through a survey.

The survey was created using and collected the responses between March 2023 and May 2023. In the survey, responses provided information on APPs demographics, their role in the management of patients with PD, and their attitude toward and use of on-demand therapy. Papesh and colleagues noted that APPs are an essential part of the multidisciplinary team for managing patients with PD. The survey had a total of 32 respondents,72% of which were nurse practitioners and 28% were physician assistants/ associates. Among all the respondents, 69% reported that they find it "moderately to very difficult" to manage PD in their patients with the given available oral baseline or adjunctive therapies.

Factors that were rated higher than emotional impact by respondents reflected the assessments that may have been grounded in historical clinical practices. Authors noted that these practices often, “stress the importance of adjusting baseline medications and predate the introduction of new on-demand treatments such as levodopa inhalation powder and sublingual apomorphine.” The differences in the most important aspect on-demand therapy benefits for patients from respondents showed a disconnect between their view of the benefit of on-demand therapy and their frequency of prescription.

“The most important perceived benefits of on-demand therapy are that they enable patients to have more control over their PD symptoms and that they have rapid onset of action. The main reason given for not prescribing on-demand therapy was affordability, followed by insurance paperwork including prior authorization,” Papesh et al wrote.1

Based on the responses on the participants role in clinical practice, 75% currently see both new consults and follow-up visits independently, and 91% can prescribe new or maintenance medications independently. Additionally, 94% of respondents are responsible for patient education and training and 25% hold an education class or offer to all their patients in their practice.

“Prioritizing the consideration of the emotional impact of living with OFF periods at most or all office visits may provide an opportunity for increased use of on-demand therapy and thus reduce the burden of unexpected symptom return for patients. These findings are consistent with recent publications and new treatment guidelines, which emphasize the role of on-demand therapies and their earlier use in managing PD,” Papesh et al noted.1

Click here for more coverage of ATMRD 2023.

1. Papesh K, Merriam A, Zebendon C. The Importance of On-Demand Therapy in Parkinson's Disease: A Survey of Advanced Practice Providers. Presented at: ATMRD; June 9-11, 2023; Washington, DC.
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