Caregivers’ and physicians’ attitudes to rotigotine transdermal patch versus oral Parkinson’s disease medication: an observational study

Figures & data

Table 1. Caregiver and Physician Questionnaire (translated from the original German language version).

Questions for Caregivers/Nurses and Physicians
Swallowing dysfunction	If your patient is suffering from swallowing dysfunction due to PD: in your experience does the application of the Neupro patch offer advantages or disadvantages in comparison with an oral therapy (capsule or tablet)?
Nausea or vomiting	If your patient has problems with nausea or vomiting due to PD: in your experience does the application of the Neupro patch offer advantages or disadvantages in comparison with an oral therapy (capsule or tablet)?
Surveillance of therapy	How do you judge the use of the Neupro patch regarding surveillance of accurateness of treatment in view of the external application and resulting 24 h visibility of the patch (in comparison to oral treatment)?
Once daily application	In your experience does the application of the Neupro patch offer advantages in comparison with an oral therapy (capsule or tablet) because your patient has to take other drugs repeatedly per day and the patch is applied once daily, or are there nevertheless disadvantages?
Application independently from meals	Does the Neupro patch in your experience offer advantages in comparison to an oral therapy (capsule or tablet) because it can be administered independently of meals, or are there disadvantages?
Application to sleeping patients	In your experience does the application of the Neupro patch offer advantages in comparison with an oral therapy (capsule or tablet) because it can also be applied while the patient is sleeping, or are there disadvantages?
Question for Caregivers/Nurses Only
Caregiving efforts	In your experience does the application of the Neupro patch offer advantages in comparison with an oral therapy (capsule or tablet) regarding the effort of caregiving, or are there disadvantages?
Questions for Physicians Only
Surgery under general anesthesia	How do you judge the use of the Neupro patch when your patient has to undergo surgery under general anesthesia and oral treatment is temporarily not possible?
Renal insufficiency	In patients suffering from renal insufficiency, in your experience does the application of the Neupro patch offer advantages in comparison with an oral therapy (capsule or tablet) because no adaptation of dosage is necessary, or are there nevertheless disadvantages?
Low risk of drug interactions	In your experience does the application of the Neupro patch offer advantages in comparison with an oral therapy (capsule or tablet) because there is only a low risk of drug interactions, or are there disadvantages?
Absorption	In your experience does the application of the Neupro patch offer advantages in comparison with an oral therapy (capsule or tablet) because absorption is not influenced by a delayed gastric evacuation, or are there disadvantages?

A question was only answered if the patient suffered from the symptom; otherwise a box was ticked indicating that the patient didn’t suffer from the symptom. Questions were assessed on a 5 point scale: ‘major disadvantages’ (-2), ‘minor disadvantages’ (1), ‘neither disadvantages, nor advantages’ (0), ‘minor advantages’ (1), and ‘major advantages’ (2) compared with oral PD treatment.

Table 2. Patient demographics and disease characteristics.

FAS; n = 147
Age, mean ± SD, years	74.6 ± 8.3
Age group, n (%)
18 to <65	17 (12)
≥65	130 (88)
Male, n (%)	87 (59)
PD duration, mean ± SD, years	8.2 ± 6.3
Hoehn and Yahr stage*, n (%)
1	8 (5)
2	20 (14)
3	53 (36)
4	53 (36)
5	12 (8)
Level of German care intensity†, n (%)
None‡	19 (13)
1	55 (37)
2	47 (32)
3	7 (5)

*Data missing from 1 patient.

†Data missing from 19 patients.

‡All patients included had documented need of care in their medical records, even if not reaching German level of care intensity of at least Level 1.

None: may have severely impaired activities of daily living, not meeting Level 1 criteria.

Level 1: daily assistance with ≥2 chores of ≥1 area of basic care (body care, nutrition, mobility). Repeated assistance for domestic help: ≥90 minutes/day on average (with >45 minutes/day for basic care).

Level 2: daily assistance with ≥3 chores of ≥1 area of basic care. Domestic help: ≥3 hours/day (≥2 hours/day for basic care).

Level 3: round-the-clock assistance with basic care. Domestic help: ≥5 hours/day (≥4 hours/day for basic care).

FAS, full analysis set; PD, Parkinson’s Disease; n, number of patients; SD, standard deviation.

Table 3. Patient mobility, activities of daily living and cognitive function§.

FAS; n = 147
Mobility
Timed up-and-go test, n (%)*
Patient with complete mobility	13 (9)
Patient with limited mobility	30 (20)
Patient with pronounced limited mobility	28 (19)
Activities of daily living
Barthel Index (%), mean ± SD†	61.00 ± 29.75
Cognitive function
MMSE, mean ± SD‡	24.02 ± 6.21
MMSE, n (%)‡
Severe (0–9)	1 (0.7)
Moderate (10–19)	5 (3)
Mild (20–25)	10 (7)
Normal (26–30)	26 (18)

§Analysis of all documented tests (i.e. may include tests that were performed >6 months prior to documentation or for which the timing could not be ensured).

*Data available for 71 patients (missing from 76 patients).

†Data available for 63 patients (missing from 84 patients).

‡Data available for 42 patients (missing from 105 patients).

FAS, full analysis set; MMSE, Mini Mental State Examination; SD, standard deviation.

Table 4. Caregiver relation.

FAS; n = 147	n (%)
Caregiving family member
Yes	100 (68)
No	40 (27)
Not recorded	7 (5)
Relationship of caregiver to patient
Spouse	72 (49)
Daughter/son	23 (16)
Other*	31 (21)
Not recorded	21 (14)
Caregiver living with attended patient
Yes	87 (59)
No	51 (35)
Not recorded	9 (6)
Professional nurse
In outpatient care	4 (3)
In nursing home	36 (24)

*Includes sister/brother/parent/other relationship.

FAS, full analysis set.

Figure 1. Mean score of all questions for assessment of rotigotine transdermal patch (Neupro) compared with oral PD treatment. The mean was calculated if at least four questions were answered. *Multiple patient assessments provided by one person were averaged to obtain a single response per caregiver/physician. PD, Parkinson’s disease; SD, standard deviation.

Figure 2. Mean score of individual questions for assessment of rotigotine transdermal patch (Neupro) compared with oral PD treatment. Number of patients for each question displayed in the bars; multiple patient assessments provided by one person were averaged to obtain a single response per caregiver/physician. PD, Parkinson’s disease; SD, standard deviation.

Figure 3. Physicians’ rationale for prescription of rotigotine transdermal patch (Neupro).