, Volume 34, Issue 1, pp 119–128 | Cite as

Medicine Administration in People with Parkinson’s Disease in New Zealand: An Interprofessional, Stakeholder-Driven Online Survey

  • Monica Amer Oad
  • Anna MilesEmail author
  • Avril Lee
  • Angela Lambie
Original Article


Medicine administration errors are twice as frequent in people with dysphagia than in those without. Medicine administration is particularly critical for people with Parkinson’s disease where late, or missed doses reduce medicine effectiveness and impact on the quality of life. The aim of this study was to explore the current medicine administration practices of people with Parkinson’s disease in New Zealand. A self-administered online survey was developed by an interprofessional group including people with Parkinson’s disease (the primary stakeholders), speech-language pathologists and pharmacists. The survey was administered using a cross-sectional study design and asked respondents about self-reported swallowing difficulties [using Eating Assessment Tool (EAT-10)], medicine regimes and strategies used to swallow medicines. Seventy-one people with Parkinson’s disease responded to the survey (69% male, mean age 72 years, mean years with Parkinson’s disease 9 years). Respondents reported complex daily multi-medicine consumption (mean no. of pills 11, range 2–25). Analyses showed that 57% of respondents scored outside the normal range for EAT-10 (> 3) with 57% complaining of difficulties with pills. Many respondents admitted to missing medicines and requiring external reminders. Multiple strategies for swallowing pills were described including crushing tablets, using yoghurt or fruit juice, and swallowing strategies (such as head tilt, effortful swallow, chin down and altered pill placement in the mouth). Medicine administration is complex and challenging for people with Parkinson’s disease. The development of educational packages for people with Parkinson’s disease, their carers and health professionals is much needed.


Dysphagia Deglutition Medicine administration Parkinson’s disease Interprofessional 



Thank you to People with Parkinson’s Inc, The Centre of Brain Research The University of Auckland, Neurological Foundation, and Parkinson’s New Zealand for support in circulation of the survey.


No funding source was involved in this research.

Compliance with Ethical Standards

Conflict of interest

All the authors have no conflicts of interest and nothing to declare.

Ethical Approval

This study was approved by an appropriate national ethics committee (UAHPEC/018753) and all respondents provided written informed consent. All procedures were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki declaration.


  1. 1.
    Abid S, Mumtaz K, Jafri W, Hamid S, Abbas Z, Shah HA, Khan AH. Pill-induced esophageal injury: endoscopic features and clinical outcomes. Endoscopy. 2005;37(8):740–4. Scholar
  2. 2.
    Bainbridge JL, Ruscin JM. Challenges of treatment adherence in older patients with Parkinson’s disease. Drugs Aging. 2009;26(2):145–55. Scholar
  3. 3.
    Barlett JE, Kotrlik JW, Higgins CC. Organizational research: determining appropriate sample size in survey research. Inf Technol Learn Perform J. 2001;19(1):43.Google Scholar
  4. 4.
    Barnett N, Parmar P. How to tailor medication formulations for patients with dysphagia. Pharm J. 2016;297(7892):1–7. Scholar
  5. 5.
    Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ. Validity and reliability of the eating assessment tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919–24. Scholar
  6. 6.
    Buetow S, Henshaw J, Bryant L, O’Sullivan D. Medication timing errors for Parkinson’s disease: perspectives held by caregivers and people with Parkinson’s in New Zealand. Parkinson’s Dis. 2010;2010(2010):1–6. Scholar
  7. 7.
    Castell JA, Johnston BT, Colcher A, Li Q, Gideon RM, Castell DO. Manometric abnormalities of the oesophagus in patients with Parkinson’s disease. Neurogastroenterol Motil. 2001;13(4):361–4.CrossRefGoogle Scholar
  8. 8.
    Cereda E, Cilia R, Klersy C, Canesi M, Zecchinelli AL, Mariani CB, Tesei S, Sacilotto G, Meucci N, Zini M, Isaias IU, Cassani E, Goldwurum S, Barichella M, Pezzoli G. Swallowing disturbances in Parkinson’s disease: a multivariate analysis of contributing factors. Parkinsonism Relat Disord. 2014;20(12):1382–7. Scholar
  9. 9.
    Cichero JAY. Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety. Nutr J. 2013;12(54):1–8. Scholar
  10. 10.
    Downey CE, Thakerar A, Kirsa S. Don’t rush to crush: audit of modification to oral medicines for patients with swallowing difficulties. J Pharm Pract Res. 2015;45(2):146–51. Scholar
  11. 11.
    Duerden M, Avery T, Payne R. Polypharmacy and medicines optimisation: making it safe and sound. London: The Kings Fund; 2013.Google Scholar
  12. 12.
    Fitzsimmons PR, Michael BD, Hulley JL, Scott GO. A readability assessment of online Parkinson’s disease information. J R Coll Physicians Edinb. 2010;40(4):292–6. Scholar
  13. 13.
    Gerlach OH, Broen MP, Van Domburg PH, Vermeij AJ, Weber WE. Deterioration of Parkinson’s disease during hospitalization: survey of 684 patients. BMC Neurol. 2012;12(1):13.CrossRefGoogle Scholar
  14. 14.
    Haw C, Stubbs J, Dickens G. An observational study of medication administration errors in old-age psychiatric inpatients. Int J Qual Health Care. 2007;19(4):210–6.CrossRefGoogle Scholar
  15. 15.
  16. 16.
    Kalf JG, de Swart BJ, Bleom BR, Munneke M. Prevalence of oropharyngeal dysphagia in Parkinson’s disease: a meta-analysis. Parkinsonism Relat Disord. 2012;18(4):311–5. Scholar
  17. 17.
    Kelly J, Wright D. Administering medication to adult patients with dysphagia. Nurs Stand. 2009;23(29):62–8.CrossRefGoogle Scholar
  18. 18.
    Kelly J, Wright D. Administering medication to adult patients with dysphagia: part 2. Nurs Stand. 2010;24(26):61–8.CrossRefGoogle Scholar
  19. 19.
    Kelly J, D’Cruz G, Wright D. A qualitative study of the problems surrounding medicine administration to patients with dysphagia. Dysphagia. 2009;24(1):49–56. Scholar
  20. 20.
    Kelly J, D’Cruz G, Wright D. Patients with dysphagia: experiences of taking medication. J Adv Nurs. 2010;66(1):82–91.CrossRefGoogle Scholar
  21. 21.
    Kikendall JW. Pill esophagitis. J Clin Gastroenterol. 1999;28(4):298–305.CrossRefGoogle Scholar
  22. 22.
    Kikendall JW, Friedman AC, Oyewole MA, Fleischer D, Johnson LF. Pill-induced esophageal injury. Dig Dis Sci. 1983;28(2):174–82.CrossRefGoogle Scholar
  23. 23.
    Leopold NA, Kagel MC. Pharyngo-esophageal dysphagia in Parkinson’s disease. Dysphagia. 1997;12(1):11–8.CrossRefGoogle Scholar
  24. 24.
    Leung W. How to design a questionnaire. Int Med J Stud. 2001;9:187–9.Google Scholar
  25. 25.
    McCarthy DM, Waite KR, Curtis LM, Engel KG, Baker DW, Wolf MS. What did the doctor say? Health literacy and recall of medical instructions. Med Care. 2012;50(4):277. Scholar
  26. 26.
    Miles A, Clark S, Jardine M, Allen J. Esophageal swallowing timing measures in healthy adults during videofluoroscopy. Ann Otorhinolaryngol. 2016;125(9):764–9. Scholar
  27. 27.
    New Zealand Formulary (NZF). 2018. NZF v(71).
  28. 28.
    Qualtrics. 2017. Qualtrics online survey software.
  29. 29.
    Sexton NR, Miller HM, Dietsch AM. Appropriate uses and considerations for online surveying in human dimensions research. Hum Dimens Wildl. 2011;16(3):154–63.CrossRefGoogle Scholar
  30. 30.
    Stegemann S, Gosch M, Breitkreutz J. Swallowing dysfunction and dysphagia is an unrecognized challenge for oral drug therapy. Int J Pharm. 2012;430(1):197–206. Scholar
  31. 31.
    Strachan I, Greener M. Medication-related swallowing difficulties may be more common than we realise. Pharm Pract. 2005;15(9):411–4.Google Scholar
  32. 32.
    Sue VM, Ritter LA. Writing survey questions. In: Sue VM, Ritter LA, editors. Conducting online surveys. Thousand Oaks: Sage Publications Inc; 2011. p. 51–76.Google Scholar
  33. 33.
    Tjaden K. Speech and swallowing in Parkinson’s disease. Top Geriatr Rehabil. 2008;24(2):115–26.CrossRefGoogle Scholar
  34. 34.
    van der Eijk M, Nijhuis FA, Faber MJ, Bloem BR. Moving from physician-centered care towards patient-centered care for Parkinson’s disease patients. Parkinsonism Relat Disord. 2013;19(11):923–7.CrossRefGoogle Scholar
  35. 35.
    Wood LD, Neumiller JJ, Carlson JD, Setter SM, Corbett CF. Challenges of medication management in hospitalized patients with Parkinson’s disease. Am J Health-Syst Pharm. 2010;67(23):2059–63.CrossRefGoogle Scholar
  36. 36.
    World Health Organisation (WHO). 2007. Medication without harm: WHO’s third global patient safety challenge.
  37. 37.
    Wright KB. Researching internet-based populations: advantages and disadvantages of online survey research, online questionnaire authoring software packages, and web survey services. J Comput-Mediat Commun. 2005;10(3):JCMC1034. Scholar
  38. 38.
    Wright D, Chapman N, Foundling-Miah M, Greenwall R, Griffith R, Guyon A, Merriman H. Consensus guideline on the medication management of adults with swallowing difficulties. Berkhamsted: Medendium Group Publishing Ltd; 2006.Google Scholar
  39. 39.
    Wright D, Chapman N, Foundling-Miah M, Greenwall R, Griffith R, Guyon A, Merriman H. Guideline on the medication management of adults with swallowing difficulties. Berkhamsted: Medendium Group Publishing Ltd; 2015.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Speech Science, School of PsychologyThe University of AucklandAucklandNew Zealand
  2. 2.Waitemata District Health Board (WDHB)AucklandNew Zealand

Personalised recommendations