Multi-disciplinary Parkinson’s care raises quality and lowers cost

Parkinson’s disease is a neurodegenerative disorder that often severely limits the functioning of patients in many domains of their lives. An analysis of a multi-disciplinary network for treatment of Parkinson’s patients has shown that costs can be reduced and adherence to evidence-based guidelines increased.

ParkinsonNet

ParkinsonNet is a multi-disciplinary approach that has been active in the Netherlands since 2005, consisting of community-based allied health professionals that, with neurologists, form a referral network. The goal was to develop expertise and improve communication between professionals treating patients with Parkinson’s.

parkinsonnet_logoParkinsonNet has expanded to more than 50 regional networks in the Netherlands. Participating professionals include neurologists, nurses, physiotherapists, speech therapists, occupational therapists, dieticians, social workers and mental health workers including psychiatrists.

There is evidence that interventions by allied health professionals can be of benefit, such as physiotherapy, occupational therapy and speech therapy. However barriers exist to the widespread involvement of allied health professionals in the treatment of Parkinson’s patients. These include a lack of disease specific knowledge and relatively low patient volumes due to a lack of specialization among these disciplines. Furthermore, poor communication between specialties limits awareness of the benefits and availability of services, resulting in less multi-disciplinary care.

A limited number of allied health professionals were invited to participate in ParkinsonNet. Initial research clarified referral patterns from neurologists to allied health professionals: 63% of patients were referred for physical therapy, 9% for occupational therapy and 14% for speech therapy. The number of invitees was based on anticipated demand for services within the referral region, with the goals of increasing volume per therapist while providing geographic accessibility for patients.

Results

A study comparing ParkinsonNet physiotherapy with normal care physiotherapy ending in 2007 reported the following results:

  • ParkinsonNet physiotherapists treated more than twice as many Parkinson’s patients. ParkinsonNet has resulted in a steady increase in the volume of Parkinson’s patients treated by participating physiotherapists. The authors estimate that at least 10 patients per year need to be treated by each physiotherapist to achieve benefit.
  • More of the ParkinsonNet physiotherapists were aware of evidence-based recommendations (100% versus 96%) and more applied these recommendations with their patients (90% versus 33%)
  • Total costs per patient were €727 lower for ParkinsonNet patients versus usual care, with additional analysis indicating that a savings of €73 million per year for Parkinson’s care in the Netherlands was realized through ParkinsonNet. The majority of savings accrued due to reduced homecare and less day-hospital rehabilitation.
  • Patient outcomes over a 16-week period did not differ significantly between groups (no decrease in dopaminergic treatment or improvement in standardized measures of disease severity was noted)

An analysis from 2009 health data indicated that patients treated in regions where ParkinsonNet was active had:

  • Lower costs
  • Higher likelihood of receiving physiotherapy, and more frequent physiotherapy
  • Lower rates of hip fractures

Motivation for professional participation

Participating professionals reported that they participated in ParkinsonNet to:

  1. Increase disease-specific knowledge
  2. Standardize skill sets and treatment protocols
  3. Increase social cohesion between care providers

They also indicated a desire to better define the scope of practice between different professionals with regards to these three domains.

 The ParkinsonNet approach

Key components of ParkinsonNet include:

  • Selection of a restricted number of allied health professionals for participation
  • Dissemination of evidence-based guidelines for care
  • A 4-day basic course focusing on multi-disciplinary treatment, guidelines and standards for physiotherapy, speech and occupational therapy
  • A 3-hour seminar covering Parkinson’s disease
  • A 1-day visit for allied health professionals to an affiliated Neurology out-patient clinic
  • A digital newsletter, a ParksinsonNet website, a standardized electronic record for physiotherapy and an on-line community for professionals and patients (www.mijnzorgnet.nl)
  • A patient information brochure and an on-line tool allowing patients to find the closest professionals who participate in ParkinsonNet (www.parkinsonnet.nl/zorgzoeker)
  • A structured, evidence-based referral form for participating professionals

In this video from TEDx Maastricht in Dr. Bas Bloem describes his vision for participatory healthcare which underlies the ParkinsonNet program.

Sources:

van der Klauw D, Munneke M, Bloem B. Beter samenwerken vanuit specialisme. Medisch Contact. 2011;13:812-821. Available from: http://medischcontact.artsennet.nl/Nieuws-26/archief-6/Tijdschriftartikel/93839/Beter-samenwerken-vanuit-specialisme.htm

Nijkrake M, Keus S, Kalf J, et. al. Allied health care interventions and complementary therapies in Parkinson’s disease. Parkinsonism and Related Disorders. 2007;13:S488-S494.

Munneke M, Nijkrake M, Keus S, et. al. Efficacy of community-based physiotherapy networks for patients with Parkinson’s disease: a cluster-randomised trial. Lancet Neurology. 2010;9:46-54.

ParkinsonNet maakt zorg beter. CVZ magazine. Dec 2011:24-25. Available from: http://www.parkinsonnet.nl/media/2728649/cvz_magazine_04_2011.pdf

Nijkrake M, Keus S, Overeem S, et. al. The ParkinsonNet Concept: Development, Implementation and Initial Experience. Movement Disorders. 2010;25(7):823-829.

Beersen N, Berg M, van Galen M, et. al. Onderzoek naar de meerwaarde van ParkinsonNet. Zorgverzekeraars Nederland. 2011. Available from: http://www.invoorzorg.nl/docs/ivz/informatiecentrum/Onderzoek-naar-de-meerwaarde-van-ParkinsonNet.pdf