The Value of Care in Parkinson’s Disease
Multidisciplinary Team Work Can Improve the Care of Families With Parkinson’s Disease
Nir Giladi Director, Movement Disorders Unit and Chairman, Department of Neurology, Tel Aviv Sourasky Medical Centre, Sackler School of Medicine, Tel Aviv University
Abstract
Parkinson’s disease (PD) is now recognised as a multidimensional disease that involves motor and non-motor symptoms. As such, a multidisciplinary team should ideally be involved in the care of patients with PD. There are several approaches or models that can be used – simple parallel, consultative or collaborative approaches are usually based on informal sharing of information, whereas coordinated, multidisciplinary and interdisciplinary approaches involve more formalised teams usually having regular meetings and making group decisions. At the Movement Disorders Unit at the Tel Aviv Medical Centre, an interdisciplinary team approach has been used for the past 15 years. The team consists of neurologists, gerontologists, a psychiatrist, nurses, a social worker, a speech, language and swallow therapist, a sexologist, physiotherapists, an occupational therapist, a dietitian, a neuropsychologist, research assistants, genetic counsellors and secretaries. The centre has clinics for PD, atypical parkinsonism focusing on multiple system atrophy, autonomic dysfunction with an autonomic laboratory, sexual counselling service, a gait and falls prevention clinic, a special clinic for demented and psychotic patients and a genetic counselling clinic. In addition, a recent clinic for prevention of PD was opened for populations at risk. The centre also provides individual counselling to carers in a special carers’ clinic and a wide variety of group therapy programmes for patients, carers and first-degree relatives. This holistic approach provides benefits to the patients, as well as their families and carers. However, published evidence on the benefits of multidisciplinary teams (or other partnering models) is lacking. The large-scale ParkinsonNet initiative in the Netherlands has not apparently resulted in improved outcomes for patients (at least not in the short term), whereas a smaller prospective study in Canada suggests improvements across a number of symptom scales. Both these surveys have measured cost savings with partnering programmes, which gives hope that despite the initial effort required to initiate team structures, they could be cost-effective in the longer term. More data are needed to confirm this suggestion.
Keywords Parkinson’s disease, multidisciplinary teams, partnering programmes
Disclosure: Nir Giladi has received grant funding from the National Institutes of Health (NIH), Michael J Fox Foundation, National Parkinson Foundation USA, Israel Science Foundation, Parkinson’s Disease Foundation USA and the European Community. He has received honoraria for presentations/lectures or advisory board meetings from Union Chimique Belge (UCB), Teva Lundbeck, NeuroDerm, Intec Pharma, Schwarz Pharma, GlaxoSmithKline, Allergan and Novartis. He has received consultancy fees from Schwarz Pharma, Teva Lundbeck, UCB, Eisai, Intec Pharma, GlaxoSmithKline, Solvay, Merz, Biogen and NeuroDerm. Acknowledgements: This work was supported by an unrestricted grant from Abbott. Editorial support was provided by Martin Gilmour, ESP Bioscience (Sandhurst, UK) funded by Abbott. Received: 21 February 2011 Accepted: 16 March 2011 Citation: European Neurological Review, 2011;6(Suppl. 1):17–20 Correspondence: Nir Giladi, Department of Neurology, Tel-Aviv Medical Centre, 6 Weizman Street, Tel-Aviv, Israel 64239. E:
nirg@tasmc.health.gov.il
Parkinson’s disease (PD) is a very complex condition. Usually, there is a brief ‘honeymoon’ period after diagnosis, during which the motor symptoms are reasonably well controlled by medication. However, after three to five years a range of symptoms, such as motor response fluctuations, dyskinesia, gait problems and falls, become an increasing problem with a major impact on mobility and independence. Importantly, it is now clear that patients with PD have a high prevalence of non-motor symptoms, such as sleep disorders, psychiatric disorders, pain, gastrointestinal symptoms, depression/anxiety, apathy, behavioural changes, psychosis and dementia.1–3
Furthermore, recent
data demonstrate that social isolation, financial burden and domestic issues contribute to the already difficult situation, from the family’s point of view.4–6
quality of life (QoL), in addition to the motor difficulties.7 be viewed as a multidimensional disease that includes:
© TOUCH BRIEFINGS 2011
These non-motor symptoms have a major impact on Thus, PD should
• motor disturbances; • autonomic disturbances; • cognitive and affective disorders; • sensory disturbances; • sleep disorders; • domestic problems; • financial difficulties; and • social difficulties.
It is crucial that a team of experts is involved in the care of such a complex condition and only a collaborative attitude by all therapists will be able to provide the multidimensional approach needed. However, the expense associated with involving a wider team cannot be ignored, and in this article the necessity of such expense is considered.
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