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Integrated care models for patients with Parkinson’s disease
Integrated care is critical for people who have Parkinson’s disease for optimal management of their complex multisystem challenges, said Professor Terry Ellis, Boston, MA, who introduced a scientific session at MDS Virtual Congress 2020 on innovative care models. Three experts then described a variety of evidence-based and innovative integrated care models for optimal and responsive management of patients throughout the course of Parkinson’s disease.
The multisystem nature of Parkinson’s disease (PD) results in a wide variety of motor, autonomic, behavioral, sensory, mood, cognitive, sleep, and other symptoms.1 Effective management patients with PD therefore involves multiple disciplines and team members, said Professor Jennifer Goldman, Chicago, IL.
An interdisciplinary care model responds to patient needs
An interdisciplinary care model has been found to provide optimal PD management, she said. It’s patient-centered approach is combined with close communication and integration of knowledge by the professionals from different disciplines throughout the course of a patient’s illness to respond to needs defined by the patient.2,3
In contrast, in a multidisciplinary care model, professionals from different disciplines work together in parallel but do not integrate their knowledge and the goals might not be defined by the patient.2,3
Integrated care models
Integrated care models optimise the management of PD
Existing integrated care models are heterogenous, including in setting, scope, and team members,2 but have been shown improve outcomes and quality of life, for example:
- day clinics improved motor and non-motor scores and quality of life4
- intensive rehabilitation improved quality of life5
- tiered screening models led to early involvement in rehabilitation programs6
- home-based care for patients with advanced PD was associated with high satisfaction and retention in the program7
Among the most important principles of a good interdisciplinary team are respect, good communication, and positive leadership and management.8
Innovative models of integrated care
Innovative models of integrated care involving telemedicine and for providing palliative care also improve outcomes for patients with PD.
Interdisciplinary telemedicine is as effective as face-to-face consultation
Interdisciplinary telemedicine presents many opportunities for improving healthcare for patients with PD,9 including access to patients in remote areas or who are housebound, said Dr Mark Guttman, of Toronto, Canada, who has used telemedicine in his management of patients with PD over the past 19 years.
He described a randomized controlled trial (RCT) of usual care compared with usual care including virtual visits. Telemedicine consultations were found to be feasible and as effective as face-to-face consultations.10
Outpatient integrated palliative care improves patient outcomes
Professor Maya Katz, San Francisco, CA, advocated an integrated outpatient palliative care model for PD, and described an RCT of outpatient integrated palliative care compared with standard care.
The integrated outpatient palliative care model produced statistically significant improvements in:
- quality of life
- nonmotor symptom burden
- motor symptom severity
- caregiver burden at 12 months11
Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
References
- Lim S-Y, et al. Neur Rev. 2009;66:167–72.
- Stember M. Social Sci J. 1991;28:1–14.
- Rajan R, et al. Mov Dis. 2020;35:1509–31.
- Frundt O, et al. J Neural Transm. 2018;125:1461–72.
- Ferrazzoli D, et al. Mov Dis. 2018;89:828–35.
- Khan U, et al. Arch Rehabil Res Clin Transl. 2020;2:100067.
- Fleischer J, et al. J Am Geriatr Soc. 2018;66:1226–32.
- Nancarrow SA, et al. Hum Resources Hlth. 2013;11:19.
- Ben-Pazi H, et al. Curr Neurol Neurosci Rep 2018;18:26.
- Beck CA, et al. Neurology. 2017;89:1152–61.
- Kluger BM, et al. JAMA Neurol. 2020;77:551–60.