July 2011
Giladi N
Parkinson’s disease (PD) is now recognised as a multidimensional disease
that involves motor and non-motor symptoms. As such, a
multidisciplinary team should ideally be involved in the care of
patients with PD.
There are several approaches or models that can be
used – simple parallel, consultative or collaborative approaches are
usually based on informal sharing of information, whereas coordinated,
multidisciplinary and interdisciplinary approaches involve more
formalised teams usually having regular meetings and making group
decisions.
At the Movement Disorders Unit at the Tel Aviv Medical
Centre, an interdisciplinary team approach has been used for the past 15
years. The team consists of neurologists, gerontologists, a
psychiatrist, nurses, a social worker, a speech, language and swallow
therapist, a sexologist, physiotherapists, an occupational therapist, a
dietitian, a neuropsychologist, research assistants, genetic counsellors
and secretaries. The centre has clinics for PD, atypical parkinsonism
focusing on multiple system atrophy, autonomic dysfunction with an
autonomic laboratory, sexual counselling service, a gait and falls
prevention clinic, a special clinic for demented and psychotic patients
and a genetic counselling clinic. In addition, a recent clinic for
prevention of PD was opened for populations at risk. The centre also
provides individual counselling to carers in a special carers’ clinic
and a wide variety of group therapy programmes for patients, carers and
first-degree relatives. This holistic approach provides benefits to the
patients, as well as their families and carers.
However, published
evidence on the benefits of multidisciplinary teams (or other partnering
models) is lacking. The large-scale ParkinsonNet initiative in the
Netherlands has not apparently resulted in improved outcomes for
patients (at least not in the short term), whereas a smaller prospective
study in Canada suggests improvements across a number of symptom
scales. Both these surveys have measured cost savings with partnering
programmes, which gives hope that despite the initial effort required to
initiate team structures, they could be cost-effective in the longer
term. More data are needed to confirm this suggestion.
