Table.
Aims and solutions to improve the management of patients with chronic neurological conditions such as Parkinson's disease
| Supportive evidence* | Minimum standard† | |
|---|---|---|
| Aim to organise care close to home | ||
| Remote monitoring | Passive monitoring of falls in home environment;10, 11 passive monitoring using mobile health technologies (eg, electronic device typing);12, 13 active monitoring (predefined tasks using smartphone to assess postural tremor or responsiveness to changes with medication);14, 15 other monitoring16 | No |
| Support patient empowerment | Use of online communities for patient communication17 | Yes |
| Online communication | Telemedicine visits by neurologists;18 interdisciplinary plan including home visits;19, 20 secure video-conferencing18, 21 | No |
| Aim to inform self-management | ||
| Focus on ability to adapt and self-manage | Education on daily life management22, 23 | Yes |
| Promote a healthy lifestyle | Encouragement of a healthy diet24 and exercise25, 26, 27 | Yes |
| Support for working capacity | Education on strategies and techniques to counteract symptoms of Parkinson's disease and enable longer workforce participation28 | Yes |
| Shared decision making | Tools for making informed shared decisions between available options for continuous dopaminergic stimulation (deep brain stimulation, intraduodenal levodopa, apomorphine)29 | Yes |
| Caregiver support | Peer-to-peer caregiver education30 | Yes |
| Aim to manage care proactively | ||
| Timely identification of specific complications | Active screening for precipitants of hospital admission such as near-falls | Yes |
| Aim to provide personalised or precision medicine | ||
| Focus on individual patient priorities | Consideration of differences between men and women in clinical presentation, treatment response, and health-care utilisation (eg, brain surgery for Parkinson's disease);31, 32, 33 consideration of racial34, 35, 36, 37 or cultural differences38, 39 | Yes |
| Big data and artificial intelligence | Personalised profiling and individualised prognostic or treatment advice40, 41, 42 | No |
| Aim to enable access to appropriate care | ||
| Parkinson-specific specialisation for all professional disciplines involved in Parkinson care, according to evidence-based guidelines | Training of commonly engaged disciplines, such as allied health professionals or specialised nurses;43, 44, 45, 46, 47, 48 training of less commonly recognised disciplines such as dentist or pulmonologist;49 inclusion of nursing home staff and clinicians involved in advanced care planning (issues at the end-of-life, palliative care)50, 51 | Yes |
| Concentration of care among trained experts (increase case load) | Dutch ParkinsonNet approach44 | Yes |
| Organising peer-to-peer networking | Implementation of interprofessional education for health-care professionals on evidence-based Parkinson's disease practices and working effectively in teams46 | Yes |
| Aim to provide coordinated care management | ||
| Coordination of care | Employment of personal care managers to coordinate care for people with Parkinson's disease52 | Yes |
| Establish links between Parkinson's disease specialists and generalists working in the community | Increased Parkinson's disease-specific knowledge among general practitioners53 | Yes |
| Telemedicine (peer-to-peer consultations) | More accurate clinical decision making in the field of acute stroke54 | No |
| To deliver integrated care and continuity of care | ||
| Breach silos by connecting all layers of health care and bundle into a model of integrated network care, both across professional disciplines and across all echelons | Some examples in the field of dementia;55 scarce examples available outside the field of neurology;56 models yet to be implemented for patients with chronic neurological conditions | Yes |
*
For each proposed solution, we provide supportive evidence, capitalising not only on the experience in the field of Parkinson's disease, but also on knowledge obtained for other conditions such as dementia8, 9 and other fields of medicine.
†
The minimum standard indicates whether a solution might be more readily available for wider scaling across other countries, health-care systems, or areas of medicine. No formal specific criteria for such minimum standards have been defined to date, so the suggestions offered here can only be used to offer some global guidance.