University of Ottawa Brain and Mind Research Institute, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Mov Disord. 2021 Feb;36(2):398-406. doi: 10.1002/mds.28332. Epub 2020 Oct 14.
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.
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).
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.
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.
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.
帕金森病（PD）是一种慢性神经退行性疾病，对护理服务提出了挑战。需要建立一种多学科的护理模式，该模式在实施上具有影响力，切实可行，并且在经济上具有生存能力，以便广泛应用。目前缺乏支持性证据。
本研究旨在评估基于综合护理、自我管理支持和技术支持的以患者为中心的护理模式的实施情况及其对新发（<1 年）和晚期（诊断>8 年）帕金森病患者的影响。
采用 6 个月的前后设计，对单中心、2 期复杂干预措施进行研究，以评估基于综合护理、自我管理支持和技术支持的以患者为中心的护理模式。我们全面评估了综合帕金森病护理网络（IPCN）计划后的护理路径实施情况、选定健康和护理质量结果的变化以及成本分析。
我们在 6 个月内招募了 100 名参与者。总体而言，最高的护理重点是言语和沟通（33.7%）、焦虑和抑郁（31.6%）以及活动能力、平衡和跌倒（29.6%），最常使用的资源（>45%）是言语语言病理学、社区老年人服务和物理疗法。90.6%的病例成功满足了护理重点，帕金森病问卷-8 （2.7；95%置信区间，0.4-5.0；在晚期组中具有统计学意义）、慢性护理支持感知（慢性疾病患者评估量表评分，1.1；95%置信区间，0.9-1.4）和自我管理（5A 评分，1.2；95%置信区间，1.0-1.4）方面均有积极变化。综合帕金森病护理网络的总费用为每位患者 1367 加元。
基于综合护理和自我管理支持的护理服务网络的务实发展在可行性、影响力和可持续成本方面具有广阔前景。
