Proactive and Integrated Management and Empowerment in Parkinson’s Disease: Designing a New Model of Care
Table 2
A hypothetical case study. Scenario 1 illustrates a chain of events resulting in an adverse outcome for a patient with PD. Scenario 2 offers an example of how this scenario could be managed differently with the application of the PRIME-Parkinson model. FRAX refers to the University of Sheffield fracture risk assessment tool [45].
Case study
Mrs. Ahmed is a 78-year-old lady who has had idiopathic PD for 5 years. She has recently begun to have a few “minor falls” which she has put down to “getting older.” She has noticed she sometimes feels dizzy when she stands up but doesn’t like to bother her GP about it and knows it can be very hard to get an appointment. She considers mentioning it to her PD consultant when she next goes to clinic in 6 months’ time but decides she won’t because she believes the dizziness probably doesn’t have anything to do with her Parkinson’s disease.
Scenario 1 (existing care model)
Mrs. Ahmed begins to feel less confident going out and stops going to social activities. While taking the bins out one evening, she has a bad fall onto a concrete path, landing on her left side. Her neighbour calls an ambulance and she is taken to hospital, where she is diagnosed with a neck of femur fracture, requiring an operation. She develops a lower respiratory tract infection and postoperative delirium, which leads to a prolonged stay in the acute hospital, following which she is transferred to a community hospital for ongoing rehabilitation.
Scenario 2 (PRIME care model)
Remembering that light-headedness was mentioned at a PRIME-Parkinson-delivered information session she had recently attended, Mrs. Ahmed contacts the single point of access helpline to discuss her concerns about her recent dizzy spells. This information is logged in the collaboration platform and relayed to Mrs. Ahmed’s Parkinson’s nurse who telephones her to discuss her symptoms further and discovers that she has also begun to have a few falls as well as a number of “near misses.” The Parkinson’s nurse explores the impact which these symptoms are having on her life; Mrs. Ahmed fears that she may not be able to attend her nephew’s wedding next month due to her dizziness and poor balance.
Together, they agree a plan of action, with the aim of helping Mrs. Ahmed achieve her goal of attending the wedding:
(i) Blood pressure (BP) and medications are reviewed; the Parkinson’s nurse suggests to the GP that he consider stopping amlodipine and Mrs. Ahmed is given advise about increasing her fluid intake, with a plan to review BP and symptoms following these changes. (ii) A referral is made to a physiotherapist, with specialist expertise in PD, who suggests a personalised exercise plan to improve her strength and balance. (iii) A referral is made to an occupational therapist (OT), with specialist expertise in PD, who visits her at home and advises some changes to reduce hazards and organises for some handrails to be installed. (iv) The Parkinson’s nurse advises that Mrs. Ahmed organise an eye test at the opticians. (v) The Parkinson’s nurse calculates a FRAX score, with PD included as a secondary cause of osteoporosis, and liaises with the GP regarding the result. (vi) Mrs. Ahmed is directed to Parkinson’s UK patient information leaflet on “Falls and Parkinson’s,” in case she wishes to read about further tips to reduce her risk of falling, and is given a leaflet on ways to improve her bone health. (vii) They agree to have a telephone appointment in 2 weeks to review how she is progressing towards her goal. (viii) The physiotherapist and OT document their input via the collaborative platform so the Parkinson’s nurse is aware of the actions which have occurred ready for the telephone follow-up.
