A multidisciplinary approach to patient care - best practice in action
Teus van Laar MD, PhD
Professor of Neurology, Director Parkinson Expertise Center Groningen, University Medical Center Groningen, University of Groningen, The Netherlands
Parkinson’s disease (PD) is a complex disorder, which needs a multidisciplinary approach during all phases, and especially if advanced treatments are started. Without such a team advanced therapies cannot be started, because of the logistic complexity and the need for extra teaching and guiding of the patients. The neurologist, PD nurse specialist (PDNS) and the patient are the core-team, which can be extended by many other allied health professionals, if needed .
An important goal of the multidisciplinary team is making the right decisions for the patients at the right moment. In case of advanced treatments, information should not be based on the personal preference of patients or doctors and/or the availability of treatments; these treatments should be offered by teams who are able to provide the whole spectrum of advanced therapies. For this reason, it is very important that patients receive equal information on all options and are stimulated to become partners in the process . Balanced information sheets may really help this shared decision making.
In the Netherlands, an integrated PD care model has been set up, based on training and collaboration between PD professionals (ParkinsonNet), mainly existing of allied health workers . This model has been analysed in the IMPACT study, which unfortunately did not find an overall benefit, nor reduction of overall costs, although patients were satisfied about these well-trained professionals . Possible explanations for this negative outcome might be the rather low implementation rate of advice provided by the neurologist and the relatively mild stages of PD included in this study.
In order to make a closer connection between the regional expertise PD centers and all connected PD professionals in the region around, the Parkinson Platform Northern Netherlands was started (PPNN). In this model the participating expertise centers (Points for Parkinson, PfP) also coordinated the overall chain of care, in order to aim for better implementation of advice, using a shared electronic patient dossier.
Long-term analysis of a group of 609 patients, having used this PfP model, compared with 5949 controls with care as usual, showed a cost reduction of about 2000 Euro per patient/year with an overall delay of definite nursing-home admission of 5 years in the PfP group vs. controls (submitted data).
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