Addressing knowledge gaps in Parkinson\u2019s disease: a report on the Movement Disorder Society\u2019s Centre-to-Centre initiative to improve Parkinson\u2019s disease services in Lao People\u2019s Democratic Republic

Wassilios G. Meissner,Roongroj Bhidayasiri,Appasone Phoumindr,Saysavath Keosodsay,Onanong Phokaewvarangkul,Somchit Vorachit,Ronald B. Postuma

doi:10.1186/s12909-020-02161-x

Abstract

BackgroundLao People’s Democratic Republic (Lao PDR) has only nine neurologists for seven million people; none have formal training in Parkinson’s disease (PD). Medical specialists require sufficient PD knowledge to provide high-quality care.MethodsThis study outlines a Centre-to-Centre programme for developing PD expertise in underserved regions through a tailored two-year educational enterprise between an established movement disorder mentor centre at Chulalongkorn University in Thailand and mentee centres in Lao PDR. Background knowledge of 80 Laotian physicians was assessed using a validated PD knowledge questionnaire containing 26 questions divided into 3 sections (diagnosis, therapeutic options, disease course) before and immediately after one-day kick-start training. Responses were compared across physicians’ demographic groups.ResultsOf 80 respondents, 50 (62.5%) were board-certified physicians, of which 27 (54%) specialised in internal medicine. Apparent knowledge gaps were shown by a 51.2% correct response rate for total score, 52.8% for diagnosis, 50.6% for therapeutic options, and 48.2% for disease course. No significant differences in total score or any domain sub-scores between neurologists and other specialties were found. Many did not know which non-motor symptoms could occur as prodromal symptoms or late in course of PD. Incorrect responses mainly reflected a lack of knowledge of the impact of medication on disease. Total and domain sub-scores significantly improved after the course (p < 0.05, each). The size of difference of the means was significant for the total score (d = 0.82), therapeutic option (d = 0.56), and disease course (d = 0.68) sub-scores.ConclusionsSignificant improvement of PD knowledge amongst Laotian physicians is demonstrated after a training course, focusing on practical management of PD. Our findings highlight the importance of continued medical education, especially PD-specific training.

Highlights

Lao People’s Democratic Republic (Lao PDR) has only nine neurologists for seven million people; none have formal training in Parkinson’s disease (PD)
Significant improvement of PD knowledge amongst Laotian physicians is demonstrated after a training course, focusing on practical management of PD
Our findings highlight the importance of continued medical education, especially PD-specific training

Summary

Introduction

Lao People’s Democratic Republic (Lao PDR) has only nine neurologists for seven million people; none have formal training in Parkinson’s disease (PD). Many regions around the world still lack sufficient resources to provide adequate care to PD patients [1, 2]. The World Medical Assembly endorses and promotes patient autonomy and access to good quality medical care without discrimination, following the Declaration of Lisbon on patients’ rights in 1984, there are notable challenges in providing equitable health care in developing countries with ageing populations, further highlighting healthcare inadequacy in underdeveloped countries [5]. It is likely that the situation in SSA is replicated in other developing countries, including Lao People’s Democratic Republic (Lao PDR), a developing country in Southeast Asia [1]; this situation in Lao PDR would exemplify the limited treatment accessibility and resources for many neurological disorders in this region [8, 9]

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