Contents

1. What does the PD Decision Support Tool do?

PD Decision Support Tool is an interactive tool designed to educate patients and healthcare professionals on the most appropriate options for initial treatment and adjustment of medications for Parkinson Disease. The tool is divided into 4 steps, which are intended to guide patients through self-assessment, comparison of alternatives, and adjustment processes.

• Step 1: The user enters information on their current medications and symptoms to determine whether the tool will give information on either: (A) starting medications for newly diagnosed PD or (B) adjusting current PD medications.
• Step 2: Medication options can be selected to compare benefits and risks. Medication regimens, costs, and other relevant considerations are displayed in the dropdown menu. A bar graph displays the incidence (%) of side effects for each medication selected. Happy faces are used indicate the relative benefit of drug classes used in PD (highest = 🙂🙂🙂; lowest = 🙂).
• Step 3: Inputs from Step 1 are used to provide guidance for self-adjusting levodopa therapy. Users are directed to discuss therapeutic alternatives requiring a prescription with their prescriber.
• Step 4: Non-drug recommendations and links to PD-related infographics are provided.

What PD Decision Support Tool doesn’t do:

• This tool is not intended for use by those with Deep Brain Stimulation (DBS) implants. People with DBS implants may still use some medications to manage their PD. We recommend discussing appropriate alternatives for use with DBS with a neurologist.

2. How do I use PD Decision Support Tool?

Step 1: Input information about current use of medication for PD, age, and PD symptoms
Step 2: Select from available drug therapy options. Compare relative benefits for motor symptom control and side effect profiles of selected options.

• Clicking on the drug names will reveal charts which show the potential benefits and side effects of each medication
• Clicking on the drop-down arrows to the right of each drug name will reveal additional information, including the type of medication, how many times per day it must be taken, the cost for a 3-month supply, and additional notes on how to best use the medication

Step 3: Click the buttons to learn more about how to adjust medications to improve symptom management

Step 4: A brief overview of non-drug management of PD.

• Follow the links to view infographics with further information about PD medications 
• Click “Share Link” to generate a link to this personalized assessment list of treatment choices for future reference.
  
• Click “Print” to create a PDF printout of the results.

Definitions

Bradykinesia: refers to when movements feel slow, or when it is difficult to start a movement
Rigidity: refers to a feeling of stiffness, tightness, or rigidity while moving
Resting Tremor: refers to the experience of shaking body parts (e.g. hands, feet) when they are not moving.
Postural Tremor: refers to when one’s hands or arms tremble or shake while being held straight out in front of the body
Wearing off: when the benefits of levodopa do not last as long as they did before
Dyskinesia: refers to involuntary body movements that are not painful

3. How were the medication options in Steps 2 & 3 chosen and where do the estimates of benefits and harms come from?

We selected medications for inclusion based on a comprehensive review of guidelines, reviews, primary literature, as well as consultation with experts. Treatments are sub-categorized by drug class, which includes: (1) Levodopa Combinations, (2) Dopamine Agonists, (3) MAO-B Inhibitors, (4) Add-on Medications.

Choices regarding which medications might be most suitable for a user were predominantly based on:

• Canada Guideline for Parkinson Disease
• Grimes, DA. Parkinson Disease In: Therapeutics [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2016 [updated JUL 2023; cited 2023 NOV 20]. Available from: http://www.myrxtx.ca. Also available in paper copy from the publisher.

For side effects, adverse events are presented as percent incidence, as reported in the manufacturer drug monographs and pilot studies.

• Percent incidence: how many people experienced the side effect out of all the people in the study, expressed as a percentage test 

4. Adverse effects and other considerations by treatment

5. Why are some medications listed as ‘Suggested’ or ‘Other’ in Step 2?

User inputs in Step 1 are used to determine whether a medication is more or less suitable

• Suggested: Most appropriate medication alternatives based on Step 1 inputs
  
• Other: Other PD medications that are available but may not be suitable based on Step 1 inputs

6. How were costs estimated?

Study Buffalo

Medi-Mouse

Readability

Flesch-Kincaid Grade Level: 10 - 12

Developed by

This tool was developed through the collaboration of:

BRAIN (Building Resources and Accessibility in Neurology) Team, University of British Columbia

Nicoline Bihelek BSc, MSc
Doctor of Pharmacy Student, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC

Dr. Larry Leung BSc (Pharm), PharmD, RPh
Associate Professor of Teaching, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC

Olivia Lee BSc
Doctor of Pharmacy Student, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC

Elizabeth Chan
Doctor of Pharmacy Student, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC

Parkinson Wellness Projects

Amy Tran BSc (Pharm), RPh
Clinical Pharmacist, Victoria, BC

Bailey Martin, BAET
Executive Director, Parkinson Wellness Projects, Victoria, BC

Dr. Keiran Tuck MD
Neurologist, Movement Disorder Specialist, Parkinson's and Movement Disorders Clinic, Victoria, BC
Clinical Assistant Professor, Royal Jubilee Hospital & Victoria General Hospital, Victoria, BC

Programmed by

Dr. Blair MacDonald BA, PharmD
PhD Student, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC

Acknowledgements 

Parkinson Disease Community Advisory Committee

Dr. Ricky Turgeon BSc(Pharm), ACPR, PharmD
Assistant Professor – Greg Moore Professor in Clinical and Community Cardiovascular Pharmacy, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
Clinical Pharmacy Specialist - PHARM-HF, St. Paul's Hospital, Vancouver, BC

Funded by: Canadian Foundation for Pharmacy’s Innovation Fund and UBC’s Community-University Engagement Fund