Utilization of rehabilitation therapy services in Parkinson disease in the United States

Michelle E Fullard, Dylan P Thibault, Andrew Hill, Joellyn Fox, Danish E Bhatti, Michelle A Burack, Nabila Dahodwala, Elizabeth Haberfeld, Drew S Kern, Olga S Klepitskava, Enrique Urrea-Mendoza, Phillip Myers, Jay Nutt, Miriam R Rafferty, Jason M Schwalb, Lisa M Shulman, Allison W Willis, Parkinson Study Group Healthcare Outcomes and Disparities Working Group, Michelle E Fullard, Dylan P Thibault, Andrew Hill, Joellyn Fox, Danish E Bhatti, Michelle A Burack, Nabila Dahodwala, Elizabeth Haberfeld, Drew S Kern, Olga S Klepitskava, Enrique Urrea-Mendoza, Phillip Myers, Jay Nutt, Miriam R Rafferty, Jason M Schwalb, Lisa M Shulman, Allison W Willis, Parkinson Study Group Healthcare Outcomes and Disparities Working Group

Abstract

Objective: To examine rehabilitation therapy utilization for Parkinson disease (PD).

Methods: We identified 174,643 Medicare beneficiaries with a diagnosis of PD in 2007 and followed them through 2009. The main outcome measures were annual receipt of physical therapy (PT), occupational therapy (OT), or speech therapy (ST).

Results: Outpatient rehabilitation fee-for-service use was low. In 2007, only 14.2% of individuals with PD had claims for PT or OT, and 14.6% for ST. Asian Americans were the highest users of PT/OT (18.4%) and ST (18.4%), followed by Caucasians (PT/OT 14.4%, ST 14.8%). African Americans had the lowest utilization (PT/OT 7.8%, ST 8.2%). Using logistic regression models that accounted for repeated measures, we found that African American patients (adjusted odds ratio [AOR] 0.63 for PT/OT, AOR 0.63 for ST) and Hispanic patients (AOR 0.97 for PT/OT, AOR 0.91 for ST) were less likely to have received therapies compared to Caucasian patients. Patients with PD with at least one neurologist visit per year were 43% more likely to have a claim for PT evaluation as compared to patients without neurologist care (AOR 1.43, 1.30-1.48), and this relationship was similar for OT evaluation, PT/OT treatment, and ST. Geographically, Western states had the greatest use of rehabilitation therapies, but provider supply did not correlate with utilization.

Conclusions: This claims-based analysis suggests that rehabilitation therapy utilization among older patients with PD in the United States is lower than reported for countries with comparable health care infrastructure. Neurologist care is associated with rehabilitation therapy use; provider supply is not.

© 2017 American Academy of Neurology.

Figures

Figure. Receipt of rehabilitation therapies by state
Figure. Receipt of rehabilitation therapies by state
The prevalence of physical therapy (PT) and occupational therapy (OT) utilization over 3 years is shown by state. *Low supply of rehabilitation therapy providers indicates the state was in the lowest tertile for provider supply. PD = Parkinson disease.

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Source: PubMed

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