Parkinson’s clinical audit: Mortality and diagnostic coding accuracy in unmedicated patients

Student prerequisites

Prefer a medical student.

How to apply

Contact the first supervisor, , to express your interest:

Ext 86075
Email toni.pitcher@otago.ac.nz

Project brief

Introduction

Parkinson’s is neurodegenerative disease with significant impacts on the quality of life of both the person with the disease and their family and support networks. Our previous research, using pharmacoepidemiology methods, provided the first nationwide estimates of the prevalence and incidence of Parkinson’s in New Zealand [1]. We found that there was a substantial reduction in the probability of Parkinson’s in those aged over 80 years of age [1]. We also found variation in the prevalence of Parkinson’s between the main ethnic groups (Māori lower than European, Pasifika, and Asian) [2] and between the District Health Boards (DHBs; prevalence higher in South Island DHBs compared to North Island DHBs) [3].

During this study we found a number of people who had a Parkinson’s diagnosis listed in the national health databases, but had never received a dispensing of anti-parkinsonian medications. Potential reasons for such a discrepancy could include; people receiving a Parkinson’s diagnosis and remaining medication-free in the initial stages of the disease or the mis-use of the Parkinson’s diagnostic code (entirely possible due to the array of medical conditions displaying parkinsonian symptoms). In order to provide more accurate estimates of Parkinson’s prevalence in the future, we need to establish why people may be assigned a diagnostic code for Parkinson’s but not receive the appropriate medication.

Also of interest is to establish the main causes of death of people with Parkinson’s in New Zealand. This is important for identifying areas where potential interventions/resources could be directed to improve that quality of life of those with the disease.

Aim

1. To establish the accuracy of the Parkinson’s diagnostic label in people with no supporting medication history.
2. To establish the main causes of death of people with Parkinson’s disease in New Zealand.

Method

A clinical audit of CDHB medical records of people identified to have a diagnosis of Parkinson’s, as recorded by Ministry of Health datasets, but no evidence of receiving anti-parkinsonian medications will be completed to establish the accuracy of the Parkinson’s diagnosis.

The audit will also involve establishing the causes of death in people listed in the national Mortality Collection as having Parkinson’s for the most recent data available (2014–2015).

Student researcher’s component of the study

The student will be responsible for carrying out the audit of medical records for individuals identified in the Canterbury District Health Board region.

References

1. Myall DJ, Pitcher TL, Pearson JF, Dalrymple-Alford JC, Anderson TJ, MacAskill MR. Parkinson's in the oldest old: Impact on estimates of future disease burden. Parkinsonism & Related Disorders. 2017 42:78-84.  doi: 10.1016/j.parkreldis.2017.06.018.
2. Pitcher TL, Myall DJ, Pearson JF, Lacey CJ, Dalrymple-Alford JC, Anderson TJ, MacAskill MR. (2018). Parkinson’s disease across ethnicities: a nationwide study in New Zealand. Movement Disorders. Accepted March 4th 2018.
3. Pitcher TL, Myall DJ, MacAskill MR, Pearson JF, Lacey C, Dalrymple-Alford J C, Anderson T J (2016). Ethnic and regional differences in Parkinson’s disease in New Zealand. Proceedings of the 34th International Winter Conference on Brain Research, 34:3.5.