Recommendations for the Organization of Multidisciplinary Clinical Care Teams in Parkinson's Disease

Danique L M Radder; Jorik Nonnekes; Marlies van Nimwegen; Carsten Eggers; Giovanni Abbruzzese; Guido Alves; Nina Browner; K Ray Chaudhuri; Georg Ebersbach; Joaquim J Ferreira; Jori E Fleisher; Peter Fletcher; Giuseppe Frazzitta; Nir Giladi; Mark Guttman; Robert Iansek; Suketu Khandhar; Jochen Klucken; Anne-Louise Lafontaine; Connie Marras; John Nutt; Michael S Okun; Sotirios A Parashos; Marten Munneke; Bastiaan R Bloem

doi:10.3233/JPD-202078

Recommendations for the Organization of Multidisciplinary Clinical Care Teams in Parkinson's Disease

J Parkinsons Dis. 2020;10(3):1087-1098. doi: 10.3233/JPD-202078.

Authors

Danique L M Radder¹, Jorik Nonnekes², Marlies van Nimwegen¹, Carsten Eggers³, Giovanni Abbruzzese⁴, Guido Alves⁵, Nina Browner⁶, K Ray Chaudhuri⁷, Georg Ebersbach⁸, Joaquim J Ferreira^{9

10}, Jori E Fleisher¹¹, Peter Fletcher¹², Giuseppe Frazzitta¹³, Nir Giladi¹⁴, Mark Guttman¹⁵, Robert Iansek¹⁶, Suketu Khandhar¹⁷, Jochen Klucken^{18

19}, Anne-Louise Lafontaine²⁰, Connie Marras²¹, John Nutt²², Michael S Okun²³, Sotirios A Parashos²⁴, Marten Munneke¹, Bastiaan R Bloem¹

Affiliations

¹ Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen, The Netherlands.
² Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation; Nijmegen, The Netherlands.
³ Department of Neurology, University Hospital of Marburg, Marburg, Germany.
⁴ Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa - IRCCS Ospedale Policlinico San Martino, Genova, Italy.
⁵ The Norwegian Center for Movement Disorders, Department of Neurology, Stavanger University Hospital, Stavanger, Norway.
⁶ University of North Carolina, Movement Disorders Center, Chapel Hill, NC, USA.
⁷ Institute of Psychiatry, Psychology & Neuroscience, Parkinson Foundation International Center of Excellence, King's College Hospital, Denmark Hill, London, UK.
⁸ Movement Disorder Clinic Beelitz-Heilstaetten, Beelitz, Germany.
⁹ Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
¹⁰ CNS - Campus Neurológico Sénior, Torres Vedras, Portugal.
¹¹ Rush University Medical Center, Chicago, IL, USA.
¹² Cheltenham General Hospital, Gloucestershire, UK.
¹³ Moriggia-Pelascini Hospital, Gravedona ed Uniti, Gravedona, Italy.
¹⁴ Neurological Institute, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv, Israel.
¹⁵ Center for Movement Disorders, Toronto, Canada.
¹⁶ Kingston Center Monash Health, Melbourne, Australia.
¹⁷ Kaiser Permanente Sacramento Medical Center, Sacramento, CA, USA.
¹⁸ Department of Molecular Neurology, University Hospital Erlangen, Erlangen, Germany.
¹⁹ Research Group Digital Health Pathways, Fraunhofer IIS, Erlangen, Germany.
²⁰ Department of Neurology and Neurosurgery, McGill Movement Disorders Clinic, McGill University, Montreal, Canada.
²¹ The Edmond J Safra Program in Parkinson's disease and the Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, Toronto, Canada.
²² Oregon & Health Science University Hospital, Portland, OR, USA.
²³ University of Florida Department of Neurology, Fixel Center for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Gainesville, FL, USA.
²⁴ Struthers Parkinson's Center, Golden Valley, MN, USA.

Abstract

Background: Optimal management in expert centers for Parkinson's disease (PD) usually involves pharmacological and non-pharmacological interventions, delivered by a multidisciplinary approach. However, there is no guideline specifying how this model should be organized. Consequently, the nature of multidisciplinary care varies widely.

Objective: To optimize care delivery, we aimed to provide recommendations for the organization of multidisciplinary care in PD.

Methods: Twenty expert centers in the field of multidisciplinary PD care participated. Their leading neurologists completed a survey covering eight themes: elements for optimal multidisciplinary care; team members; role of patients and care partners; team coordination; team meetings; inpatient versus outpatient care; telehealth; and challenges towards multidisciplinary care. During a consensus meeting, outcomes were incorporated into concept recommendations that were reviewed by each center's multidisciplinary team. Three patient organizations rated the recommendations according to patient priorities. Based on this feedback, a final set of recommendations (essential elements for delivery of multidisciplinary care) and considerations (desirable elements) was developed.

Results: We developed 30 recommendations and 10 considerations. The patient organizations rated the following recommendations as most important: care is organized in a patient-centered way; every newly diagnosed patient has access to a core multidisciplinary team; and each team has a coordinator. A checklist was created to further facilitate its implementation.

Conclusion: We provide a practical tool to improve multidisciplinary care for persons with PD at the organizational level. Future studies should focus on implementing these recommendations in clinical practice, evaluating their potential applicability and effectiveness, and comparing alternative models of PD care.

Keywords: Parkinson’s disease; guideline; interdisciplinary; multidisciplinary; organization of care; practice-based evidence.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Checklist
Consensus
Delivery of Health Care* / organization & administration
Delivery of Health Care* / standards
Evidence-Based Practice* / organization & administration
Evidence-Based Practice* / standards
Health Care Surveys
Humans
Neurologists*
Parkinson Disease / therapy*
Patient Advocacy
Patient Care Team* / organization & administration
Patient Care Team* / standards
Patient Preference*
Patient-Centered Care* / organization & administration
Patient-Centered Care* / standards
Practice Guidelines as Topic* / standards
Tertiary Care Centers* / organization & administration
Tertiary Care Centers* / standards

Abstract

Publication types

MeSH terms

Grants and funding