Comparison of two types of extension tubes for people with Parkinson's disease in advanced treatment with levodopa-entacapone-carbidopa intestinal gel infusions: a prospective, crossover quality study

BMJ Open Qual. 2024 Feb 15;13(1):e002612. doi: 10.1136/bmjoq-2023-002612.

Abstract

Background: Within Parkinson's disease (PD) management, a pivotal juncture often arises when individuals with PD (PwP) necessitate advanced therapies to stabilise symptom fluctuations and reduce off-periods, which are intrinsic to living with PD. One such intervention is the infusion of duodenal levodopa-entacapone-carbidopa intestinal gel (LECIG), which confers a more dependable levodopa plasma concentration compared with conventional oral therapy. It involves the insertion of a percutaneous endoscopic gastrojejunostomy (PEG-J) tube, facilitating direct access to the stomach and jejunum. Then, a slender tube extends into the small intestine, facilitating the continuous delivery of LECIG via a portable pump. The PEG-J incorporates an extension tube that permits patients with PD to connect the medication pump.

Objective: The objective of this study was to assess and compare two types of extension tubes a standard; a standard tube and the ENFit extension tube.

Method: Employing a prospective, crossover design at a single centre in Denmark. Each participant evaluated both extension tubes for 14 days. The primary outcome measure was patient-reported evaluation measures through a nine-item questionnaire using a 5-point Likert scale and 10th open-ended qualitative question.

Results: Of the 12 recruited PwP, 10 successfully completed both testing periods and submitted self-reported questionnaires. The participants, with an average age of 70.3 years, comprised three men and seven women. Among them, five had a spouse or cohabitant, while five lived independently (with one residing in a nursing home). The average duration of PD diagnosis was 16.4 years, with an average of 2.6 years since the implantation of the medication pump. The ENFit tube outperformed the standard tube across all nine evaluation criteria, particularly excelling in terms of usability (items 4-6), safety (item 2) and overall product preference (item 9).

Keywords: Patient education; Patient safety; Patient satisfaction; Quality improvement; Self Care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antiparkinson Agents / therapeutic use
  • Carbidopa / therapeutic use
  • Catechols*
  • Cross-Over Studies
  • Female
  • Humans
  • Levodopa* / therapeutic use
  • Male
  • Nitriles*
  • Parkinson Disease* / drug therapy
  • Prospective Studies

Substances

  • Levodopa
  • Carbidopa
  • entacapone
  • Antiparkinson Agents
  • Catechols
  • Nitriles