Step two: starting the consultation 

Medicines are usually prescribed around the time of diagnosis of the disease but some patients may choose not to take the medicines until they feel ready to do so. 

NICE guidance recommends that each Parkinson’s patient is managed by a specialist multidisciplinary team, including a consultant neurologist and specialist nurse. It is rare for hospitals to have their own dedicated pharmacist for this disease, so community pharmacists’ role with regards to patients and their PD medicines is important.

To give appropriate advice, pharmacists need to know the context in which the new medicine has been prescribed. It is useful to first explain to the patient the purpose and likely length of the consultation, so as not to repeat information that might already have been given in hospital. 

Start by finding out about how the medicine came to be prescribed (the patient may have been referred following an outpatient or GP visit). Other suggested talking points at the start of the consultation include explaining your role as a community pharmacist with regards to counselling about new medicines (including the NMS where relevant) and ongoing support. 

“Tell me about your hospital visit”

• This will give you an insight as to what has already been discussed at the patient’s hospital appointments (i.e. diagnosis, treatment, prognosis)
• You will be able to determine what the patient has already been told about the medicine/s by the prescriber. Bear in mind that information may be forgotten or misremembered
• Tailor your consultation to what needs to be discussed or rediscussed to ensure full patient understanding of their medicines.

For example – is this a first prescription because:

• This is the first time that PD medicines have been prescribed? (Note that the first prescription could be from the hospital or GP)
• A medicine has been changed?
• A new medicine has been added to the regimen?

Non-motor symptoms

A large part of living with PD are the non-motor symptoms. Some can occur years before formal diagnosis, but they can also start in the early or later stages of the disease. Symptoms are diverse and can differ for each individual. They are not the focus of this module but it is important to be aware of those that occur most frequently.