Management of Parkinson’s Disease in Primary Care: Implications for the Health System

Parkinson’s Disease in Primary Care

Abstract

to significant increases in disability-adjusted life years (DALYs) and mortality rates. This case study explores the management of a 69-year-old male patient with PD and multimorbidity and, through it, attempts to find the place of primary care in this situation. The patient, who travelled about 400 kilometres for specialist care, exemplifies the barriers faced by those with neurodegenerative disorders in India. Diagnosed with PD alongside Type 2 Diabetes Mellitus and Hypertension, his treatment regimen included multiple medications aimed at managing both his neurological and metabolic conditions. Assessment revealed that the patient was not only vitally stable but also that symptoms of the various diseases were fairly well controlled. However, his mask-like facies and festinating gait gave away his underlying neurodegeneration. Given the limitations of specialised care availability, primary care facilities can effectively monitor medication adherence, provide lifestyle modifications, and facilitate rehabilitation services, thereby allowing neurologists to focus on more severe cases. This case stresses the importance of integrated care frameworks in non-communicable disease (NCD) clinics, which can be adapted to include the management of neurodegenerative diseases. We propose a primary care package, encapsulated in the acronym DOPAMINE (Diagnose early, Occupational therapy, Physical activity/Physiotherapy, Adequate diet and Adherence to drugs, Mental health and Music therapy; Individualised care; Neurology consultation when needed; eSanjeevani), as a start towards the desirable integration of chronic neurodegenerative diseases into primary care. Through the lens of this case report, the authors wish to advocate for systemic reforms that enhance the role of primary care in managing PD.