title: A cross-sectional study of clinical management, and provision of health services and their utilisation, by patients with Parkinson's disease in urban and regional Victoria.
abstract: Our objective was to evaluate and compare clinical management, utilisation of health services and quality of life (QoL) in patients with Parkinson's disease (PD) attending clinics in urban and regional Victoria. A cross-sectional survey was conducted on 210 patients with PD attending specialist neurological clinics in a regional area (Ballarat) (n=97), and an urban area (Melbourne) (n=113), Victoria. Demographic characteristics of patients with PD, QoL, patterns of disease and management and utilisation of medical and allied health services were analysed. Compared to patients with PD from urban clinics, patients in the regional clinic were significantly older and were diagnosed at a later age with a shorter duration of treatment (all p<0.05). Despite no significant difference in disease severity (measured by Unified Parkinson's Disease Rating Scale scores) between the groups, patients in the urban clinic reported a lower QoL (p=0.003). Patients in the regional clinic were more satisfied with their treatment, despite seeing their medical specialist less frequently (p<0.001) and having a higher rate of early misdiagnosis (p=0.015). Patients from regional clinics reported a poorer understanding of their illness than patients in the urban clinic (p=0.049). Half of all respondents were interested in using telemedicine services. Two-thirds (71%) of all patients used allied health services, with patients in the urban clinic utilising more and desiring greater access to these services (p<0.05). In conclusion, we found significant differences in the presentation, management and use of health services between patients accessing regional and urban PD clinics in Victoria. Telemedicine may be an effective, and even desirable, method for facilitating improved diagnosis and referral for appropriate therapies.
authors.affiliation: School of Medicine, Sydney, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.
authors.forename: Michal
authors.initials: M
authors.lastname: Lubomski
authors.forename: R Louise
authors.initials: RL
authors.lastname: Rushworth
authors.forename: Will
authors.initials: W
authors.lastname: Lee
authors.forename: Kelly
authors.initials: K
authors.lastname: Bertram
authors.forename: David R
authors.initials: DR
authors.lastname: Williams
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012016:Reference Values; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D019037:Urban Health Services / Q000706:statistics & numerical data*; D014739:Victoria / Q000453:epidemiology