Pilot Evaluation of a Pragmatic Network for Integrated Care and Self-Management in Parkinson's Disease

Tiago A Mestre; Dorothy Kessler; Diane Côté; Clare Liddy; Kednapa Thavorn; Monica Taljaard; David Grimes

doi:10.1002/mds.28332

Pilot Evaluation of a Pragmatic Network for Integrated Care and Self-Management in Parkinson's Disease

Mov Disord. 2021 Feb;36(2):398-406. doi: 10.1002/mds.28332. Epub 2020 Oct 14.

Authors

Tiago A Mestre^{1

2

3}, Dorothy Kessler^{4

5}, Diane Côté², Clare Liddy^{5

6}, Kednapa Thavorn^{2

7

8}, Monica Taljaard^{2

7

8}, David Grimes^{1

2

3}

Affiliations

¹ University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada.
² Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
³ Division of Neurology, Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada.
⁴ School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
⁵ C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada.
⁶ Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁷ The Ottawa Method's Center, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
⁸ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.

PMID: 33280165
DOI: 10.1002/mds.28332

Abstract

Background: Parkinson's disease (PD) is a chronic neurodegenerative disorder that challenges care provision. A multidisciplinary care model needs to be impactful, feasible, and viable economically for widespread utilization. Supportive evidence is lacking.

Objective: The objective of this study was to evaluate the implementation and impact of a pragmatic network for PD care, the Integrated Parkinson Care Network (IPCN).

Methods: A 6-month, pre-post design, single-center, phase 2 study for complex interventions for patients with newly diagnosed (<1 year) and advanced (diagnosis >8 years) PD was used to assess a patient-centered care model based on integrated care, self-management support, and technology-enabled care. We comprehensively assessed the implementation of care paths, change in selected health and care quality outcomes after the Integrated Parkinson Care Network program, and costs analyses.

Results: We recruited 100 participants in 6 months. Overall, the top care priorities were speech and communication (33.7%), anxiety and depression (31.6%), and mobility, balance, and falls (29.6%), and the most commonly (>45%) used resources were speech-language pathology, community seniors services, and physiotherapy. Care priorities were met successfully in 90.6% of the cases, and there was a positive change in the Parkinson's Disease Questionnaire-8 (2.7; 95% confidence interval, 0.4-5.0; statistically significant in the advanced group), the perception of support for chronic care (Patient Assessment of Chronic Illness Case score, 1.1; 95% confidence interval, 0.9-1.4), and self-management (5As score, 1.2; 95% confidence interval, 1.0-1.4). The total cost of the Integrated Parkinson Care Network was C$1367 per patient.

Conclusions: A pragmatic development of a care delivery network based on integrated care and self-management support is promising for its feasibility, impact, and a sustainable cost. © 2020 International Parkinson and Movement Disorder Society.

Keywords: Parkinson's disease; integrated care; self-management support; technology-enabled care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Delivery of Health Care, Integrated*
Humans
Parkinson Disease* / therapy
Pilot Projects
Self-Management*
Surveys and Questionnaires