Abstract Details

Title Access to Subspecialty Care for Advanced Parkinson’s Disease

Topic Movement Disorders

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 16-012

Objective Characterize subspecialty referral patterns for advanced Parkinson’s disease (PD) by demographics.

Background Only 9% of patients with advanced PD receive subspecialty care despite evidence that such care improves outcomes. Limited understanding of referral pathways may contribute to underutilization of subspecialty care, representing a critical gap in equitable access to effective therapies.

Design/Methods Retrospective cohort study of patients with advanced PD, defined as ICD-10 diagnoses of PD with fluctuations and/or dyskinesia (G20.A2, B1 and B2), in a large health network, between 2020 and 2024. Referrals to the affiliated academic subspecialty clinic were defined as system-entered referrals to a movement specialist. Referral completion, defined as referred patients with a completed encounter with a movement specialist, was tracked. Demographic and clinical characteristics were compared using t-tests and chi-square tests.

Results

Among 3,037 patients with advanced PD (mean age 74.1±9.1years, range 36–93; 62.7%male), 690 (22.7%) were referred to subspecialists, of whom 533 (77.2%) completed at least one visit. Patients referred were younger (72.0 vs. 74.7years, p<0.001), partnered (69.7% vs. 64.8%, p=0.044), more likely to reside in urban counties (56.7% vs. 33.4%, p<0.001), and predominantly from outside the system (81.9%, p<0.001). Referral completion was more common among older (72.2 vs. 71.3years, p=0.025), male (64.4% vs. 51.0%, p=0.002), partnered (71.5% vs. 63.1%, p=0.032), and externally referred patients (84.0% vs. 74.5%, p=0.006). Race/ethnicity distributions did not differ significantly in either analysis.

Conclusions In one of the largest integrated health systems in the region, only one in five patients with advanced PD were referred to an academic movement disorders center, with most referrals originating externally. Referral gaps may reflect issues in triage between general neurology and specialty clinics, patient reluctance to travel to academic centers, and a “learned helplessness” among referrers who perceive limited access. Future studies should examine these system- and provider-level drivers to inform interventions that improve access.

Authors/Disclosures
Sana Aslam, DO (University of Colorado) PRESENTER	Dr. Aslam has nothing to disclose.
Amy W. Amara, MD PhD (University of Colorado Anschutz Medical Center)	The institution of Dr. Amara has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Photopharmics, Inc. The institution of Dr. Amara has received research support from Michael J Fox Foundation for Parkinson's Research . The institution of Dr. Amara has received research support from Biogen Idec. The institution of Dr. Amara has received research support from NIH.
Emily L. Forbes, MD (University of Colorado)	The institution of Dr. Forbes has received research support from MJFF. The institution of Dr. Forbes has received research support from Biohaven. The institution of Dr. Forbes has received research support from Neurocrine. The institution of Dr. Forbes has received research support from Biogen. The institution of Dr. Forbes has received research support from BIAL.
Michelle Fullard, MD (University of Colorado Anschutz)	Dr. Fullard has received research support from Davis Phinney Foundation. Dr. Fullard has received research support from Michael J. Fox Foundation. The institution of Dr. Fullard has received research support from NIH BIRCWH K12. Dr. Fullard has received research support from Lorna G. Moore Faculty Launch Fund.
Samantha K. Holden, MD, MS, FAAN (University of Colorado School of Medicine)	The institution of Dr. Holden has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cognition Therapeutics.

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