2.202 Use of dopamine agonists and levodopa in Germany: Do German neurologists adhere to national Parkinson guidelines?

Abstract

Objective: To investigate whether German neurologists put Parkinson’s disease (PD) guidelines to daily practice, exemplified by the actual use of dopamine agonists (DA) and L-Dopa compared to the recommendations of the national guideline (NG). Method: We analysed data on treatments and health status of 451 patients with idiopathic PD. Data was taken from a cross-sectional survey of 60 neurologists in Germany (Adelphi DSP Wave II 2004). The German NG (11/06/2003) was translated into 4 decision rules – 2 for patients aged 70+ and 2 for those under 70 – regarding the use of DA and L-Dopa according to disease stage and presence of long-term motor complications. Adherence to these rules was compared separately within two groups of doctors: one stating to follow the NG and one not stating to follow the NG. Results: As asserted by responding neurologists, 306 patients (68%) were treated according to the NG. As implied by rule 1 (“no DA without L-Dopa in 70+”), neurologists in the “guideline group” used less DA without L-Dopa than the other neurologists (1.5% vs 7% respectively, p = 0.081). As per rule 2 (“L-Dopa = base-therapy if no complications, patients 70+”), L-Dopa was clearly dominating as basal treatment in the “guideline group” as well as the “non-guideline group” (91% vs 71% respectively, p = 0.065). Rule 3 (“in patients <70, start with DA monotherapy”) was observed for 49% of patients in the “guideline group” as opposed to 28% in “nonguideline group” (p = 0.087). Observation of rule 4 (“DA = basal therapy if no complications, patients <70”) was relatively comparable: 80% vs. 70% in the respective groups (p = 0.174). Conclusion: German neurologists generally initiate treatments with DA and L-Dopa which is in high agreement with the NG. Those who claimed to follow the NG tend to adhere to it more strictly. Overall, the NG appears to be relatively well-accepted.