Interdisciplinary Home Visits for Individuals with Advanced Parkinson's Disease and Related Disorders

Abstract

Parkinson's disease (PD) is a complex, multisymptom, neurodegenerative disease affecting primarily older adults. With progression, many individuals become homebound and removed from coordinated, expert care, resulting in excess morbidity, mortality, and healthcare expenditures in acute care settings and institutions. Home visit care models have achieved the triple aim of improving individual and population health while reducing costs in many frail, community-dwelling geriatric cohorts. This study details a novel, interdisciplinary home visit program specifically designed for individuals with PD and related disorders and their family caregivers built upon best practice principles in the care of multimorbid older adults. At each quarterly home visit, a movement disorders-trained neurologist, social worker, and nurse work in parallel with the individual and caregiver to complete a history, physical, detailed medication reconciliation, psychosocial needs assessment, and home safety assessment. A comprehensive, person-centered plan is agreed upon, referrals to community resources are made, standardized documentation is shared, and follow-up communication is instituted. In the first 2 years, 272 visits were conducted with 85 individuals who represent one of the oldest, most disabled PD populations reported. Satisfaction with and retention in the program were high. This study represents the first translation of the success of interdisciplinary and home-based geriatric care models to a population with a specific neurological disease. Preliminary evidence supports the need for such programs in vulnerable populations. Future studies will prospectively assess person-centered outcomes, the effect of using telemedicine on sustainability, and cost effectiveness.

Integrated Care in Parkinson's Disease: A Systematic Review and Meta‐Analysis

“…We included 48 records in the qualitative review, from which 37 studies met the inclusion and exclusion criteria. The study characteristics of 8 randomized, controlled trials (RCTs) included in the quantitative meta‐analysis and 19 other experimental studies included in the systematic review are presented in Table . The remaining 10 articles included in our systematic review were nonexperimental (ie, review articles or descriptions of care models) and are detailed separately in Supplementary Table 1 …”

“…2 for geographical map), although large parts of the world remained underrepresented. Table presents the characteristics and results of all studies, including the RCTs included in the meta‐analysis, as well as other studies included in the systematic review (nonrandomized, controlled trials, pretest/posttest designs, observational cohort studies, and retrospective chart reviews) . In the online supplementary materials, Supplementary Table 1 presents articles with detailed descriptions of proposed care models and other related reviews of care models specific to integrated care in PD .…”

Multimorbidity and Frailty: Tackling Complexity in Parkinson’s Disease

“…Recognition and management of complexity is likely to improve quality of life and prognosis for patients [ 55 ]. A more biopsychosocial model of care [ 56 ] that comprises regular, comprehensive patient assessment by an integrated team; case management; personalised care plans, prioritising patients’ goals and preferences; self-management support for patients [ 57 ] is advocated, feasible and successful [ 58 ]. Future research studies should seek to enrol patients who are representative of the population living with PD, multimorbidity and frailty to make findings generalisable to this prevalent, yet under-represented group.…”

A New Day: The Role of Telemedicine in Reshaping Care for Persons With Movement Disorders

“…26 Dr. Jori Fleisher and colleagues have demonstrated the feasibility and value of providing such care from a Parkinson' specialist, nurse, and social worker. 27 House calls are the gold standard of patient-centered care but are time-and resource intense. Indeed, a recent study in Germany found that many patients with Parkinson's disease were ineligible to receive a house call by a Parkinson's nurse specialist simply because travel distances were too long.…”