Since Parkinson’s is a complex disease involving both motor and non-motor symptoms, there is strong research interest in the effectiveness of multidisciplinary teams in delivering Parkinson’s therapies and support.

Multidisciplinary teams involve experts in various Primary and Allied Health fields working together as a team, consulting one another and above all communicating effectively to improve outcomes for Parkinson’s patients – and their carers and families.

There are several models of multidisciplinary teamwork currently being evaluated:

• The parallel model where independent healthcare practitioners share a clinic, so patients can meet different experts in a single location.
• The consultative model (common in Australia) which involves exchanges of advice between experts – usually through a formal letter about each patient. This model works on an ad hoc and case-by-case basis.
• The collaborative model where independent healthcare workers interact and share information on a particular patient on an ad hoc and informal basis. This is different from the consultative model in which the information is usually sent in one direction.
• The coordinated model that requires a formal administrative structure and a case coordinator (or case manager) who facilitates communication and sharing of patient records among a team of healthcare workers.
• The interdisciplinary team approach that that requires Primary and Allied Health team members working to a consensus model and making decisions through regular face-to-face meetings.

Two countries are leading in the development and evaluation of these models – Israel, with its Movement Disorders Unit at the Tel Aviv Medical Centre and The Netherlands with its ParkinsonNet initiative. Both were established in 2004.

Movement Disorders Unit, Tel Aviv Medical Centre

The Movement Disorders Unit at the Tel Aviv Medical Centre takes an interdisciplinary team approach.

The team consists of neurologists, gerontologists, a psychiatrist, nurses, a social worker, a speech therapist, a sexologist, physiotherapists, an occupational therapist, a dietitian, a neuropsychologist, research assistants, genetic counsellors and secretaries.

The centre has clinics for Parkinson’s, atypical parkinsonism focusing on multiple system atrophy, an autonomic laboratory, sexual counselling service, a gait and falls prevention clinic, a special clinic for dementia and psychosis patients and a genetic counselling clinic. In addition, a clinic for prevention of Parkinson’s was recently opened for populations at risk.

The centre also provides individual counselling to carers in a dedicated clinic, as well as a wide variety of group therapy programs for patients, carers and family members.

The Movement Disorders Unit treats people living with Parkinson’s over the long term (many years).

ParkinsonNet, The Netherlands

ParkinsonNet was created by a neurologist and physiotherapist at Radboud University Medical Center after their research concluded that the lack of Parkinson’s- specific knowledge among allied health professionals – along with an absence of practice guidelines – was producing “…unacceptable variations in the quality of care, with sub-optimal health outcomes and high costs as a result.”

ParkinsonNet was developed with the goal of providing the best possible care to Parkinson’s patients and their families, with an emphasis on home- and community-based care. The program has since expanded to cover the whole country.

It consists of geographically based, multidisciplinary networks of Allied Health professionals who are committed to providing services to Parkinson’s patients using evidence-based practice guidelines.

The program is facilitated by an information technology platform which can be accessed by patients, carers and families to provide real time feedback on quality of care and outcomes.

ParkinsonNet includes 69 regional networks involving more than 3,000 Allied Health professionals, including nurses and physical, occupational, and speech therapists

These regional networks are organised around hospitals. Before joining a network, Allied Health professionals are required to receive specialised training on therapies and support for Parkinson’s patients. They also pay a small annual membership fee that contributes to the costs of the ParkinsonNet national coordination centre.

Each regional network also includes neurologists, nursing home physicians, rehabilitation specialists, psychiatrists and psychologists, pharmacists, social workers, and sex therapists.

Local coordinators who are usually nurses or occupational therapists administer the network and organise local education programs

The networks were developed as a way of implementing evidence-based practice guidelines and increasing patient volume (and therefore practitioner experience) for healthcare professionals serving Parkinson’s patients

They also support communication among those professionals and serve as a resource for neurologists as well as for Parkinson’s patients, carers and families.

Sources:

1. Gray, D. Sarnak, M. Tanke 2016 ParkinsonNet: An Innovative Dutch Approach to Patient-Centered Care for a Degenerative Disease
2. Giladi 2011 Multidisciplinary Team Work Can Improve the Care of Families With Parkinson’s Disease
3. Wade, H. Gage, C. Owen, P. Trend, C. Crossmith, J. Kaye 2003 Multidisciplinary rehabilitation for people with Parkinson’s disease: a randomised controlled study

M.van der Marck, H. Kalf, I. Sturkenboom, M. Nijkrake, M. Munneke, B. Bloem 2009 Multidisciplinary Care for Patients with Parkinson’s Disease