Current approaches for the management of Parkinson’s disease in Chinese hospitals: a cross-sectional survey

Being one of the most common neurodegenerative disease worldwide, Parkinson’s disease (PD), with its high prevalence and incidence among aged people, carries a huge economic burden in China and presents with some unique features in Chinese population [1]. To address the aging crisis, the Chinese Parkinson’s Disease & Movement Disorders Society (CMDS), Neurology Branch of Chinese Medical Association has consecutively issued three versions of management guidelines for PD since 2006 [2‐4]. Drawing upon four eminent guidelines globally ahead, which were formulated respectively by the Movement Disorder Society (MDS) [5], the American Academy of Neurology (AAN) [6‐9], the European Federation of Neurological Societies (EFNS) [10], and the UK’s National Institute for Health and Care Excellence (NICE) [11]—the CMDS guidelines aim to guide the general direction of PD treatment in order to improve the current management standards in China. A key unique individualized treatment recommendation was the principles of dosage titration and a satisfactory clinical effect with a low dose, i.e., “low and slow”, should be followed to avoid acute adverse reactions and to reduce the incidence of long-term motor complications, as important therapeutic strategies in optimizing and standardizing treatment. Specifically, we recommend the principles of medication should be aiming at an optimal status for working and living quality, rather than full-dosage administration [12].

Aiming to acquire the real situation of PD treatment in China, in 2011 we conducted a pilot survey and the results showed significant differences in treatment options and an obvious variation before and after referring of PD guidelines among GPs, general neurologists and movement disorders specialists [13]. Given the relatively small sample size of enrolled doctors involved previously, we launched a national survey at a larger scale and specify our research on the latest edition of the PD guideline, hoping to update our awareness of current PD management in China and measure the impact of the latest version (2014). Thus, this survey would evaluate the status quo and shed new light on the future control and management of PD.

The purpose of this investigation is to determine at what level our neurologists are on the PD recognition and therapeutic methods. The current situation in China concerning PD management is that this disease is not only treated in neurological department, but non-neurology as well. What’s more, the attending doctors are not simply limited to PD professions, but general neurologist of no PD-treating experience, or even physicians of other departments also. We deem it necessary to gain a thorough and validated situation of status quo on how the PD treatment is really carried out in China and the differences in therapeutic level among doctors of distinguished backgrounds. Supposing that the results of this survey shows significant differences in PD recognition and treatment methods, it is hopefully an optimal guidance for further reformation and improvement in this particular field.

During stage 1, we gathered information of participants involved in this study and classified their backgrounds. Female doctors made up of 57% of the total, and 66% of the samples were in the age group of 35–60 years. With 78% of them selected in first-tier or quasi first-tier cities and 98% worked in tertiary class hospitals, we could determine that this study is highly representative in large public hospitals among capital cities with integrated financial and economic centers in China. During stage 2, we asked the participants to fill in the questionnaire which contains clinical tendency on PD and their personal understanding on certain therapy. We found that the most notable discrepancies came from the feedbacks given by doctors of different specialties. Among which, highly significant differences were seen not only in guideline reference, academic exchanging, researching experience, but were not rare in detailed diagnostic methods like Madopar loading test on suspected patients and MRI application. Situations like these further substantiate our hypothesis that PD treatment in China have not been completely standardized so far. When compared on the ground of distinguished levels of hospitals and cities, we discovered minor differences, indicating the fact that the diagnostic and therapeutic level among hospitals and cities are generally similar, with no significant differences exposed. During stage 3, we discovered an inspirational phenomenon that the treating methods and PD recognition have prominently ameliorated after referring to the CMDS guidelines. Moreover, symptoms presented on PD patients have been significantly improved as well, as over half of the doctors surveyed reported improvements in their patients. Specifically, 36.8% of the participants confirmed an over 50% of improvements during clinical practice; while 62.1 and 63.1% of participants affirmed a reduction in patients with wearing off phenomenon and peak-dose dyskinesia, respectively. In short, the guideline is markedly beneficial to reasonable PD medications strategy, and hopefully, its dissemination will greatly enhance the standard of our PD management.

Compared to the guidelines issued before represented by MDS, etc., CMDS guidelines has a relatively short history. When first issued in 2006, it has been updated regularly and remained one of the young members among the family of PD guidelines worldwide. Its localization strategy in optimizing and standardizing management of PD, especially its emphasis about “low and slow”, have covered a large range of patients in need, and is conducive to disease management in a prolonged period [5, 6]. Inspirationally, we found that the clinical guideline is already helping the standardization of practice via improving the level of clinicians. It not only improved the diagnostic accuracy, but decreased the motor complications as well, which is in consistent with another study we have done recently [6].

However, since the survey was performed on doctors from tertiary class hospitals only, with no data gathered from the patients, we have not drawn any objective statistics that could directly show the improvement of the effectiveness of PD management and the health condition on patients’ perspective. Further researches need to be conducted in order to make up for this deficiency.

In general, the CMDS guidelines has demonstrated a clear impact on therapeutic strategies for PD, and the clinical management of PD in China could be improved considerably if the deficiencies revealed in this study could be effectively addressed. Hopefully, the wider dissemination of the CMDS guidelines will greatly enhance the standard of China’s PD management continuatively in the long run.