1
|
Fujita T, Iwaki M, Hatono Y. The role of nurses for patients with Parkinson's disease at home: a scoping review. BMC Nurs 2024; 23:318. [PMID: 38730392 PMCID: PMC11088224 DOI: 10.1186/s12912-024-01931-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Parkinson's disease is a neurodegenerative disease, and many patients are cared for at home by nurses. Parkinson's disease nurse specialists have been certified in several countries. This study aimed to provide an overview of what is known about the role of nurses in the care of patients with Parkinson's disease at home and to determine the differences between nurses and Parkinson's disease nurse specialists. METHODS A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. PubMed, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature were searched (keywords: Parkinson's disease AND nurse AND [community OR home]) for studies published in English up to September 2023 describing the nurse's role in caring for patients with Parkinson's disease at home. Studies without abstracts were removed, along with protocols, systematic reviews, and studies concerned with other diseases or including data that were difficult to distinguish from those of other diseases. Roles were described and organized by category. RESULTS A total of 26 studies were included. The nurses' roles were categorized as overall assessment and support, treatment management, safety assessment regarding falls, care for non-motor symptoms, palliative care, support for caregivers, education for care home staff, multidisciplinary collaboration, and provision of information on social resources. Medication management and education of care home staff were identified as roles of nurse specialists. CONCLUSIONS This study revealed the role of nurses caring for patients with Parkinson's disease at home. Because of the complexity of the patients' medication regimens, nurse specialists provide assistance, especially with medication management and the provision of education to care staff. This study will facilitate the preparation of nurses to acquire the knowledge and skills necessary to help patients with Parkinson's disease, even in countries where Parkinson's disease nurse specialists are not officially certified, and will help patients feel comfortable with the care they receive.
Collapse
Affiliation(s)
- Takako Fujita
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, 812-8582, Fukuoka, Japan.
| | - Miho Iwaki
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, 812-8582, Fukuoka, Japan
| | - Yoko Hatono
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, 812-8582, Fukuoka, Japan
| |
Collapse
|
2
|
Vester LB, Haahr A, Nielsen TL, Bartolomeu S, Portillo MC. A Parkinson care-coordinator may make a difference: A scoping review on multi-sectoral integrated care initiatives for people living with Parkinson's disease and their caregivers. PATIENT EDUCATION AND COUNSELING 2023; 116:107931. [PMID: 37604024 DOI: 10.1016/j.pec.2023.107931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE To identify multi-sectoral integrated care initiatives for people with Parkinson's disease and caregivers. METHOD Following the Matrix Method we created a synthesis of literature across methodological approaches. The search was conducted in four databases until June 2022, and included studies focusing on multi-sectoral integrated care initiatives, and how they helped people with Parkinson's disease and caregivers in everyday living. RESULTS The search yielded 5921 articles of which nine were included. We identified four topics describing characteristics of multi-sectoral integrated care initiatives: 1) Peer-support, 2) Personalised care plan, 3) One-off initiatives limited in time and 4) Presence of a coordinator. And four topics describing how the initiatives helped in everyday living: 1) Confidence, trust and support, 2) Positive changes in health outcomes, 3) Quality of life, coping skills & psychosocial adjustment, and 4) A strengthened multi-agent collaboration and personalised assistance. CONCLUSION Multi-sectoral integrated care initiatives should be ongoing offers, and include a Parkinson care-coordinator, who can enhance multi-sectoral communication and an individualised approach to information about resources responsive to evolving needs at different disease stages. PRACTICE IMPLICATIONS Initiatives should be multidisciplinary, multi-sectoral and aimed at people with Parkinson's disease and caregivers, preferably facilitated by a care-coordinator to promote cross-sectoral communication.
Collapse
Affiliation(s)
- Louise Buus Vester
- Department of Nursing, VIA University College, Randers, Denmark; Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Denmark.
| | - Anita Haahr
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Denmark; Department of Nursing, VIA University College, Aarhus, Denmark; Nursing and Healthcare, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Tove Lise Nielsen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Denmark; Department of Occupational Therapy in Aarhus, VIA University College, Aarhus, Denmark
| | - Sandra Bartolomeu
- NIHR Applied Research Collaboration Wessex, School of Health Sciences, University of Southampton, Southampton, UK
| | - Mari Carmen Portillo
- NIHR Applied Research Collaboration Wessex, School of Health Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
3
|
Fleisher JE, Suresh M, Levin ME, Hess SP, Akram F, Dodson D, Tosin M, Stebbins GT, Woo K, Ouyang B, Chodosh J. Learning to PERSEVERE: A pilot study of peer mentor support and caregiver education in Lewy body dementia. Parkinsonism Relat Disord 2023; 113:105492. [PMID: 37385161 PMCID: PMC10527787 DOI: 10.1016/j.parkreldis.2023.105492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/07/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Lewy Body Disease (LBD) is the second most common neurodegenerative disorder. Despite high family caregiver strain and adverse patient and caregiver outcomes, few interventions exist for LBD family caregivers. Based on a successful peer mentoring pilot study in advanced Parkinson's Disease, we revised the curriculum of this peer-led educational intervention incorporating LBD caregiver input. OBJECTIVE We assessed feasibility of a peer mentor-led educational intervention and its impact on LBD family caregivers' knowledge, dementia attitudes, and mastery. METHODS Using community-based participatory research, we refined a 16-week peer mentoring intervention and recruited caregivers online through national foundations. Experienced LBD caregiver mentors were trained and matched with newer caregiver mentees with whom they spoke weekly for 16 weeks, supported by the intervention curriculum. We measured intervention fidelity biweekly, program satisfaction, and change in LBD knowledge, dementia attitudes, and caregiving mastery before and after the 16-week intervention. RESULTS Thirty mentor-mentee pairs completed a median of 15 calls (range: 8-19; 424 total calls; median 45 min each). As satisfaction indicators, participants rated 95.3% of calls as useful, and at week 16, all participants indicated they would recommend the intervention to other caregivers. Mentees' knowledge and dementia attitudes improved by 13% (p < 0.05) and 7% (p < 0.001), respectively. Training improved mentors' LBD knowledge by 32% (p < 0.0001) and dementia attitudes by 2.5% (p < 0.001). Neither mentor nor mentee mastery changed significantly (p = 0.36, respectively). CONCLUSIONS This LBD caregiver-designed and -led intervention was feasible, well-received, and effective in improving knowledge and dementia attitudes in both seasoned and newer caregivers. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04649164ClinicalTrials.gov Identifier: NCT04649164; December 2, 2020.
Collapse
Affiliation(s)
- Jori E Fleisher
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Madhuvanthi Suresh
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Melissa E Levin
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA; Chicago Medical School - Rosalind Franklin University, North Chicago, IL, USA
| | - Serena P Hess
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Faizan Akram
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | | | - Michelle Tosin
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Katheryn Woo
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Joshua Chodosh
- Department of Medicine, New York University School of Medicine, New York, NY, USA; Medicine Service, VA New York Harbor Healthcare System, New York, NY, USA
| |
Collapse
|
4
|
Fleisher JE, Suresh M, Klostermann EC, Lee J, Hess SP, Myrick E, Mitchem D, Woo K, Sennott BJ, Witek NP, Chen SM, Beck JC, Ouyang B, Wilkinson JR, Hall DA, Chodosh J. IN-HOME-PDCaregivers: The effects of a combined home visit and peer mentoring intervention for caregivers of homebound individuals with advanced Parkinson's disease. Parkinsonism Relat Disord 2023; 106:105222. [PMID: 36446676 PMCID: PMC9825655 DOI: 10.1016/j.parkreldis.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Family caregivers of people with advanced Parkinson's Disease (PD) are at high risk of caregiver strain, which independently predicts adverse patient outcomes. We tested the effects of one year of interdisciplinary, telehealth-enhanced home visits (IN-HOME-PD) with 16 weeks of peer mentoring on caregiver strain compared with usual care. METHODS We enrolled homebound people with advanced PD (PWPD) and their primary caregiver as IN-HOME-PD dyads. We trained experienced PD family caregivers as peer mentors. Dyads received four structured home visits focused on advanced symptom management, home safety, medications, and psychosocial needs. Starting at approximately four months, caregivers spoke weekly with a peer mentor for 16 weeks. We compared one-year change in caregiver strain (MCSI, range 0-72) with historical controls, analyzed intervention acceptability, and measured change in anxiety, depression, and self-efficacy. RESULTS Longitudinally, IN-HOME-PD caregiver strain was unchanged (n = 51, 23.34 (SD 9.43) vs. 24.32 (9.72), p = 0.51) while that of controls worsened slightly (n = 154, 16.45 (10.33) vs. 17.97 (10.88), p = 0.01). Retention in peer mentoring was 88.2%. Both mentors and mentees rated 100% of mentoring calls useful, with mean satisfaction of 91/100 and 90/100, respectively. There were no clinically significant improvements in anxiety, depression, or self-efficacy. CONCLUSIONS Interdisciplinary telehealth-enhanced home visits combined with peer mentoring mitigated the worsening strain observed in caregivers of less advanced individuals. Mentoring was met with high satisfaction. Future caregiver-led peer mentoring interventions are warranted given the growing, unmet needs of PD family caregivers. TRIAL REGISTRATION NCT03189459.
Collapse
Affiliation(s)
- Jori E Fleisher
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Madhuvanthi Suresh
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Ellen C Klostermann
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Jeanette Lee
- Department of Social Work and Community Health, Rush University Medical Center, 710 South Paulina Street, Chicago, IL, 60612, USA.
| | - Serena P Hess
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Erica Myrick
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Daniela Mitchem
- Department of Social Work and Community Health, Rush University Medical Center, 710 South Paulina Street, Chicago, IL, 60612, USA.
| | - Katheryn Woo
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Brianna J Sennott
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Natalie P Witek
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Sarah Mitchell Chen
- Department of Social Work and Community Health, Rush University Medical Center, 710 South Paulina Street, Chicago, IL, 60612, USA.
| | - James C Beck
- Parkinson's Foundation, 1359 Broadway, Suite 1509, New York, NY, 10018, USA.
| | - Bichun Ouyang
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Jayne R Wilkinson
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA; Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Deborah A Hall
- Department of Neurological S,ciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, 227 E. 30th Street, TRB 839, New York, NY, 10016, USA; VA New York Harbor Healthcare System, Medicine Service, 423 E. 23rd Street, New York, NY, 10010, USA.
| |
Collapse
|
5
|
Olvera CE, Levin ME, Fleisher JE. Community-based neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:49-66. [PMID: 36599515 DOI: 10.1016/b978-0-12-824535-4.00001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Community-based palliative care is defined as palliative care delivered outside of the hospital and outpatient clinics. These settings include the home, nursing homes, day programs, volunteer organizations, and support groups. There is strong evidence outside of the neuropalliative context that community-based palliative care can reduce hospital costs and admissions at the end of life. Research that focuses on specialized community-based palliative care for neurologic disease have similar findings, although with significant variability across conditions and geographic locations. Several of these studies have investigated home-based care for neurologic conditions including dementia, Parkinson's disease, multiple sclerosis, brain tumors, and motor neuron disease. Other work has focused on incorporating palliative care models into the treatment of patients with neurologic diseases within nursing home settings. Similar to nonneurologic community-based palliative care, little has been published on patient and caregiver quality-of-life outcomes in such models of care, although the emerging data are generally positive. Future studies should explore how best to provide comprehensive, cost-effective, scalable, and replicable models of community-based neuropalliative care, patient and caregiver outcomes in such models, and how care can be adapted between and within specific patient populations and healthcare systems.
Collapse
Affiliation(s)
- Caroline E Olvera
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States; Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, United States
| | - Melissa E Levin
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States; Chicago Medical School-Rosalind Franklin University, North Chicago, IL, United States
| | - Jori E Fleisher
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States.
| |
Collapse
|
6
|
van Munster M, Stümpel J, Thieken F, Ratajczak F, Rascol O, Fabbri M, Clemens T, Czabanowska K, Mestre TA, Pedrosa DJ. The Role of Parkinson Nurses for Personalizing Care in Parkinson’s Disease: A Systematic Review and Meta-Analysis. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1807-1831. [PMID: 35786660 PMCID: PMC9535548 DOI: 10.3233/jpd-223215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Quality of life (QoL) of persons with Parkinson’s disease (PD) is diminished by (non-)motor symptoms, that require personalized care. Parkinson Nurses (PN) may be pivotal promoting tailored care offerings. This systematic review and meta-analysis investigates PD care models and aims at furnishing current concepts of PN to offer personalized care. Objective: The purpose of this study is to identify the various roles and functions that PN may hold for personalized PD care. Methods: We performed a systematic literature review, utilizing: PubMed, Web of Science, The Cochrane Library, and PsycINFO. The review qualitatively evaluated articles, which described personalized care models involving PNs and was guided by the personalized care management model. A meta-analysis compared patient-reported QoL (quantified using the 39-item Parkinson’s Disease Questionnaire) between personalized care interventions involving PN versus standard care with. Results: Twenty-seven publications were identified, including six randomized, controlled trials ascertaining with health related QoL (n = 1830 PwPs). The qualitative evaluation revealed that PN contribute to all aspects of personalized care. The meta-analysis showed no improved QoL in personalized care models compared to standard care, thought a great heterogeneity among study design and interventions was outlined (Standardized Mean Difference = –0.8935; 95% Confidence Interval, –2.1177 to 0.3307; z = –1.43, p = 0.1526). Conclusion: PN fulfil important functions in personalized PD care. For the future, a clear role definition will be necessary to adjust training for PN across healthcare systems and care settings but especially to realize their full potential for PD care.
Collapse
Affiliation(s)
- Marlena van Munster
- Department of Neurology Philipps University Marburg, University Hospital Marburg, Marburg, Germany
- Department of International Health, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Johanne Stümpel
- Cologne Centre for Ethics, Rights, Economics, and Social Sciences of Health (CERES), University of Cologne, Cologne, Germany
- Center for Life Ethics, University of Bonn, Bonn, Germany
| | - Franziska Thieken
- Department of Neurology Philipps University Marburg, University Hospital Marburg, Marburg, Germany
| | - Florin Ratajczak
- Helmholtz Zentrum München: German Research Center for Environmental Health, Institute of Network Biology, Neuherberg, Germany
| | - Olivier Rascol
- Department of Clinical Pharmacology and Neurosciences, Toulouse Parkinson Expert Centre Toulouse NeuroToul Center of Excellence in Neurodegeneration (COEN) and the French NS-Park/F-CRIN network, University of Toulouse 3, CHU of Toulouse, INSERM, Toulouse, France
| | - Margherita Fabbri
- Department of Clinical Pharmacology and Neurosciences, Toulouse Parkinson Expert Centre Toulouse NeuroToul Center of Excellence in Neurodegeneration (COEN) and the French NS-Park/F-CRIN network, University of Toulouse 3, CHU of Toulouse, INSERM, Toulouse, France
| | - Timo Clemens
- Department of International Health, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Katarzyna Czabanowska
- Department of International Health, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
- Jagiellonian University, Department of Health Policy Management, Institute of Public Health, Faculty of Health Sciences, Krakow, Poland
| | - Tiago A. Mestre
- Parkinson Disease and Movement Disorders Centre, Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - David J. Pedrosa
- Department of Neurology Philipps University Marburg, University Hospital Marburg, Marburg, Germany
| | | |
Collapse
|
7
|
Fleisher JE, Hess SP, Klostermann EC, Lee J, Myrick E, Mitchem D, Niemet C, Woo K, Sennott BJ, Sanghvi M, Witek N, Beck JC, Wilkinson JR, Ouyang B, Hall DA, Chodosh J. IN-HOME-PD: The effects of longitudinal telehealth-enhanced interdisciplinary home visits on care and quality of life for homebound individuals with Parkinson's disease. Parkinsonism Relat Disord 2022; 102:68-76. [PMID: 35963046 PMCID: PMC9578443 DOI: 10.1016/j.parkreldis.2022.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Homebound individuals with advanced Parkinson's disease (PD) are underrepresented in research and care. We tested the impact of interdisciplinary, telehealth-enhanced home visits (IN-HOME-PD) on patient quality of life (QoL) compared with usual care. METHODS Nonrandomized controlled trial of quarterly, structured, telehealth-enhanced interdisciplinary home visits focused on symptom management, home safety, medication reconciliation, and psychosocial needs (ClinicalTrials.gov NCT03189459). We enrolled homebound participants with advanced PD (Hoehn & Yahr (HY) stage ≥3). Usual care participants had ≥2 visits in the Parkinson's Outcomes Project (POP) registry. We compared within- and between-group one-year change in QoL using the Parkinson's Disease Questionnaire. RESULTS Sixty-five individuals enrolled in IN-HOME-PD (32.3% women; mean age 78.9 (SD 7.6) years; 74.6% white; 78.5% HY ≥ 4) compared with 319 POP controls, with differences in age, race, and PD severity (37.9% women; mean age 70.1 (7.8) years; 96.2% white; 15.1% HY ≥ 4). Longitudinally, the intervention group's QoL remained unchanged (within-group p = 0.74, Cohen's d = 0.05) while QoL decreased over time in POP controls (p < 0.001, Cohen's d = 0.27). The difference favored the intervention (between-group p = 0.04). POP participants declined in 7/8 dimensions while IN-HOME-PD participants' bodily discomfort improved and hospice use and death at home-markers of goal-concordant care-far exceeded national data. CONCLUSIONS Telehealth-enhanced home visits can stabilize and may improve the predicted QoL decline in advanced PD via continuity of care and facilitating goal-concordant care, particularly among diverse populations. Extrapolating features of this model may improve continuity of care and outcomes in advanced PD.
Collapse
Affiliation(s)
- Jori E. Fleisher
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA,Rush Graduate College, Rush University Medical Center, 600 South Paulina Street, Suite 438, Chicago, IL, 60612, USA,Corresponding author. Department of Neurological Sciences, Division of Movement Disorders, 1725 W. Harrison Street, Suite 755, Chicago, IL 60612, USA. (J.E. Fleisher)
| | - Serena P. Hess
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Ellen C. Klostermann
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Jeanette Lee
- Department of Social Work and Community Health, Rush University Medical Center, 701 South Paulina Street, Chicago, IL, 60612, USA.
| | - Erica Myrick
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Daniela Mitchem
- Department of Social Work and Community Health, Rush University Medical Center, 701 South Paulina Street, Chicago, IL, 60612, USA.
| | - Claire Niemet
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Katheryn Woo
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA; Loyola University Chicago College of Arts and Sciences, 1032 West Sheridan Road, Chicago, IL, 60660, USA.
| | - Brianna J. Sennott
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA,Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 1118, Chicago, IL, 60612, USA
| | - Maya Sanghvi
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Natalie Witek
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - James C. Beck
- Parkinson’s Foundation, 1359 Broadway, Suite 1509, New York, NY, 10018, USA
| | - Jayne R. Wilkinson
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA,Department of Neurology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 1118, Chicago, IL, 60612, USA.
| | - Deborah A. Hall
- Division of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, 227 E. 30th Street, TRB 839, New York, NY, 10016, USA; VA New York Harbor Healthcare System, Medicine Service, 423 E. 23rd Street, New York, NY, 10010, USA.
| |
Collapse
|
8
|
Han YH, Yoo SH, Lee SY, Hwang IY, Kim KH, Cho B, Kim MS, Choi W, Kim Y. The Medical Needs and Characteristics of Cancer and Progressive Neurologic Disease Patients Who Use Home-Based Medical Care in Korea: A Retrospective Study for 2011-2020. J Am Med Dir Assoc 2022; 23:1634-1641.e2. [PMID: 35926572 DOI: 10.1016/j.jamda.2022.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/08/2022] [Accepted: 06/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the needs and characteristics of patients with cancer and neurologic disorders requiring home-based medical care (HBMC). DESIGN Retrospective observational study. SETTING AND PARTICIPANTS Patients receiving HBMC on discharge from a tertiary hospital in Korea during 2011-2020. METHODS Patients were classified into 3 disease groups: cancer, progressive neurologic disorders (NR), and others. Characteristics and medical needs were assessed in each disease group. Medical needs were categorized based on functional items requiring support or management at the time of registration: respiratory, feeding, urinary system, drain tube, central catheter, wound, medication, and other. Patients with multiple medical needs were assigned to multiple categories. Patients who used HBMC for more than 3 months were defined as long-term users; their characteristics were evaluated in the same way. RESULTS Of the total 655 patients, 47.0% (308) had cancer and 17.3% (113) were NR patients. Among all patients, 78.8% were partially dependent (44.0%) or completely dependent (34.8%) in daily activities, and there were more dependent patients in the NR group (80.5%) than cancer (26.6%). Patients with cancer needed central catheter management the most (43.5%), followed by wound care (36.7%), feeding support (35.1%), and drain tube management (22.1%). NR patients required feeding support the most (80.5%), followed by respiratory support (43.4%), wound care (41.6%), and urinary system support (19.5%). Of all patients, 30.2% (198) were long-term users (NR, 37.9%; cancer, 35.4%). Long-term users were common among patients who needed respiratory support (59.4%), feeding support (48.75), and urinary system support (34.6%). CONCLUSIONS AND IMPLICATIONS Homebound patients with cancer and progressive neurologic disorders need medical services at home after discharge. Patients who need feeding and respiratory support usually use HBMC for more than 3 months. Further studies are needed to design an optimal HBMC that continuously provides medical services to patients with serious illnesses living at home.
Collapse
Affiliation(s)
- Yo Han Han
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shin Hye Yoo
- Center for Palliative care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea; College of Medicine, Seoul National University, Seoul, Republic of Korea.
| | - In Young Hwang
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyae Hyung Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Belong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Sun Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wonho Choi
- Center for Palliative care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yejin Kim
- Center for Palliative care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
9
|
Hess SP, Levin M, Akram F, Woo K, Andersen L, Trenkle K, Brown P, Ouyang B, Fleisher JE. The impact and feasibility of a brief, virtual, educational intervention for home healthcare professionals on Parkinson's Disease and Related Disorders: pilot study of I SEE PD Home. BMC MEDICAL EDUCATION 2022; 22:506. [PMID: 35761252 PMCID: PMC9238152 DOI: 10.1186/s12909-022-03430-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Individuals with advanced Parkinson's Disease (PD) and Parkinson-related disorders (PRD) are frequently referred for home allied therapies and nursing care, yet home healthcare professionals have limited training in PD/PRD. While recognizing the need for such care, patients and families report home healthcare professionals are unfamiliar with these conditions, which may be driven by neurophobia and may contribute to suboptimal care and early termination of services. We sought to determine the feasibility and effects of a virtual, multimodal educational intervention on PD knowledge, confidence, and empathy among home health professionals. METHODS Home health nurses, occupational therapists, physical therapists and physical therapy assistants, and speech-language pathologists participated in a daylong, virtual symposium on advanced PD/PRD, combining focused lectures, discipline-specific breakout sessions, immersive virtual reality vignettes, and interactive panels with both patients and families, and movement disorders and home healthcare experts. Participants completed online pre- and post-symposium surveys including: demographics; PD/PRD knowledge (0-10 points possible); empathy (Interpersonal Reactivity Index); and 10-point scales of confidence with and attitudes towards individuals with PD/PRD, respectively. Pre-post intervention changes and effect sizes were evaluated with paired t-tests and Cohen's d. We performed qualitative analyses of post-symposium free-text feedback using a grounded theory approach to identify participants' intentions to change their practice. RESULTS Participants had a mean improvement of 3.1 points on the PD/PRD knowledge test (p < 0.001, d = 1.97), and improvement in confidence managing individuals with PD/PRD (p = 0.0003, d = .36), and no change in empathy. The interactive, virtual format was rated as effective by 95%. Common themes regarding symposium-motivated practice change included: interdisciplinary collaboration; greater involvement and weighting of the patient and caregiver voice in care plans; attention to visit scheduling in relation to patient function; recognition and practical management of the causes of sudden change in PD/PRD, including infections and orthostatic hypotension. CONCLUSIONS A virtual, multimodal, brief educational pilot intervention improved PD/PRD-specific knowledge and confidence among home healthcare nurses and allied health professionals. Future studies are necessary to test the short- and long-term effects of this intervention more broadly and to investigate the impact of this education on patient and caregiver outcomes.
Collapse
Affiliation(s)
- Serena P Hess
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Melissa Levin
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
- Chicago Medical School - Rosalind Franklin University, 3333 Green Bay Road, North Chicago, IL, 60064, USA
| | - Faizan Akram
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Katheryn Woo
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
- Loyola University Chicago College of Arts and Sciences, 1032 W. Sheridan Road, Chicago, IL, 60660, USA
| | - Lauren Andersen
- Department of Physical Therapy, Rush University Medical Center, 1725 W. Harrison Street, Suite 440, Chicago, IL, 60612, USA
- Rush Physical Therapy, Select Medical, 1725 W. Harrison Street, Chicago, IL, 60612, USA
| | - Kristie Trenkle
- Rush Physical Therapy, Select Medical, 1725 W. Harrison Street, Chicago, IL, 60612, USA
- Department of Occupational Therapy, Rush University Medical Center, 1725 W. Harrison Street, Suite 440, Chicago, IL, 60612, USA
| | - Patricia Brown
- Memorycare Corporation, 634 Brooklyn Drive, Aurora, IL, 60502, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Jori E Fleisher
- Department of Neurological Sciences, Section of Movement Disorders, Rush University Medical Center, 1725 W. Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| |
Collapse
|
10
|
Leung T, Akram F, Lee J, Klostermann EC, Hess SP, Myrick E, Levin M, Ouyang B, Wilkinson J, Hall D, Chodosh J. Peer Mentoring Program for Informal Caregivers of Homebound Individuals With Advanced Parkinson Disease (Share the Care): Protocol for a Single-Center, Crossover Pilot Study. JMIR Res Protoc 2022; 11:e34750. [PMID: 35481819 PMCID: PMC9185354 DOI: 10.2196/34750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Homebound individuals with advanced Parkinson disease (PD) require intensive caregiving, the majority of which is provided by informal, family caregivers. PD caregiver strain is an independent risk factor for institutionalization. There are currently no effective interventions to support advanced PD caregivers. Studies in other neurologic disorders, however, have demonstrated the potential for peer mentoring interventions to improve caregiver outcomes. In the context of an ongoing trial of interdisciplinary home visits, we designed and piloted a nested trial of caregiver peer mentoring for informal caregivers of individuals with advanced PD. OBJECTIVE The aim of this study was to test the feasibility of peer mentoring for caregivers of homebound individuals with advanced PD and to evaluate its effects on anxiety, depression, and caregiver strain. METHODS This was a single-center, 16-week pilot study of caregiver peer mentoring nested within a year-long controlled trial of interdisciplinary home visits. We recruited 34 experienced former or current family caregivers who completed structured mentor training. Caregivers enrolled in the larger interdisciplinary home visit trial consented to receive 16 weeks of weekly, one-to-one peer mentoring calls with a trained peer mentor. Weekly calls were guided by a curriculum on advanced PD management and caregiver support. Fidelity to and satisfaction with the intervention were gathered via biweekly study diaries. Anxiety, depression, and caregiver strain were measured pre- and postmentoring intervention at home visits 2 and 3. RESULTS Enrollment and peer-mentor training began in 2018, and 65 caregivers enrolled in the overarching trial. The majority of mentors and mentees were White, female spouses or partners of individuals with PD; mentors had a mean of 8.7 (SD 6.4) years of caregiving experience, and 33 mentors were matched with at least 1 mentee. CONCLUSIONS This is the first study of caregiver peer mentoring in PD and may establish an adaptable and sustainable model for disease-specific caregiver interventions in PD and other neurodegenerative diseases. TRIAL REGISTRATION ClinicalTrials.gov NCT03189459; http://clinicaltrials.gov/ct2/show/NCT03189459. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34750.
Collapse
Affiliation(s)
| | | | | | | | | | - Erica Myrick
- RUSH UNIVERSITY MEDICAL CENTER, Chicago, US.,Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, US
| | - Melissa Levin
- RUSH UNIVERSITY MEDICAL CENTER, 1725 w Harrison St., Chicago, US.,Chicago Medical School, Rosalind Franklin University, North Chicago, US
| | - Bichun Ouyang
- RUSH UNIVERSITY MEDICAL CENTER, 1725 w Harrison St., Chicago, US
| | - Jayne Wilkinson
- RUSH UNIVERSITY MEDICAL CENTER, 1725 w Harrison St., Chicago, US.,Department of Neurology, University of Pennsylvania, Pennsylvania, US
| | - Deborah Hall
- RUSH UNIVERSITY MEDICAL CENTER, 1725 w Harrison St., Chicago, US
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, 227 E. 30th St.TRB 839, New York, US.,VA New York Harbor Healthcare System, Medicine Service, New York, US
| |
Collapse
|
11
|
Personalized Care in Late-Stage Parkinson’s Disease: Challenges and Opportunities. J Pers Med 2022; 12:jpm12050813. [PMID: 35629235 PMCID: PMC9147917 DOI: 10.3390/jpm12050813] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 12/11/2022] Open
Abstract
Late-stage Parkinson’s disease (LSPD) patients are highly dependent on activities of daily living and require significant medical needs. In LSPD, there is a significant caregiver burden and greater health economic impact compared to earlier PD stages. The clinical presentation in LSPD is dominated by motor and non-motor symptoms (NMS) that most of the time have a sub-optimal to no response to dopaminergic treatment, especially when dementia is present. Non-pharmacological interventions, including physiotherapy, cognitive stimulation, speech, occupational therapy, and a specialized PD nurse, assume a key role in LSPD to mitigate the impact of disease milestones or prevent acute clinical worsening and optimize the management of troublesome NMS. However, the feasibility of these approaches is limited by patients’ cognitive impairment and the difficulty in delivering care at home. The present care challenge for LSPD is the ability to offer a person-centered, home-delivered palliative care model based on Advanced Care Planning. An ongoing European multicentric project, PD_Pal, aims to address this challenge.
Collapse
|
12
|
Prigatano GP, Salins N. End of Life Neuropsychological Impairments and Psychological Care of Persons With Advanced Parkinsonism. Am J Hosp Palliat Care 2021; 39:962-965. [PMID: 34607486 DOI: 10.1177/10499091211049798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Decline in executive functioning, before frank dementia occurs, has been reported in patients with a history of stroke and malignant brain tumors. This may also be true in patients with advanced Parkinson's disease (PD). In this paper, we summarize the limited research on the motor and cognitive predictors of mortality in advanced PD. We then provide 2 case vignettes of patients with end of life advanced PD who demonstrated a substantial decline in working memory and speech festination. We contrast these patients' neuropsychological features to a third patient with advanced PD who shows no signs of impending death. Monitoring neuropsychological signs of executive dysfunction, explaining the neuropsychological dysfunctions to the patient and spouse while recognizing the past and retained cognitive competencies of the person is an important component of end of life psychological care. In the context of this type of consultation, the patient may experience an opportunity to communicate their emotional concerns prior to death which further reduces the anxiety associated with death.
Collapse
Affiliation(s)
- George P Prigatano
- Department of Clinical Neuropsychology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Naomi Salins
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| |
Collapse
|
13
|
Phanhdone T, Drummond P, Meisel T, Friede N, Di Rocco A, Chodosh J, Fleisher J. Barriers to Vaccination Among People with Parkinson's Disease and Implications for COVID-19. JOURNAL OF PARKINSONS DISEASE 2021; 11:1057-1065. [PMID: 33935103 DOI: 10.3233/jpd-202497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients with Parkinson's disease (PD) are at higher risk of vaccine-preventable respiratory infections. However, advanced, homebound individuals may have less access to vaccinations. In light of COVID-19, understanding barriers to vaccination in PD may inform strategies to increase vaccine uptake. OBJECTIVE To identify influenza and pneumococcal vaccination rates, including barriers and facilitators to vaccination, among homebound and ambulatory individuals with PD and related disorders. METHODS Cross-sectional US-based study among individuals with PD, aged > 65 years, stratified as homebound or ambulatory. Participants completed semi-structured interviews on vaccination rates and barriers, and healthcare utilization. RESULTS Among 143 participants, 9.8% had missed all influenza vaccinations in the past 5 years, and 32.2% lacked any pneumococcal vaccination, with no between-group differences. Homebound participants (n = 41) reported difficulty traveling to clinic (p < 0.01) as a vaccination barrier, and despite similar outpatient visit frequencies, had more frequent emergency department visits (31.7% vs. 9.8%, p < 0.01) and hospitalizations (14.6% vs. 2.9%, p = 0.03). Vaccine hesitancy was reported in 35% of participants, vaccine refusal in 19%, and 13.3% reported unvaccinated household members, with no between-group differences. Nearly 13% thought providers recommended against vaccines for PD patients, and 31.5% were unsure of vaccine recommendations in PD. CONCLUSION Among a sample of homebound and ambulatory people with PD, many lack age-appropriate immunizations despite ample healthcare utilization. Many participants were unsure whether healthcare providers recommend vaccinations for people with PD. In light of COVID-19, neurologist reinforcement that vaccinations are indicated, safe, and recommended may be beneficial.
Collapse
Affiliation(s)
- Tiffany Phanhdone
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Patrick Drummond
- Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Talia Meisel
- College of Medicine, SUNY Downstate Health Sciences University, , Brooklyn, NY, USA
| | | | | | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University School of Medicine, New York, NY, USA.,VA New York Harbor Healthcare System, Medicine Service, New York, NY, USA
| | - Jori Fleisher
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|
14
|
Fleisher J, Hess S, Sennott B, Myrick E, Wallace EK, Lee J, Sanghvi M, Woo K, Ouyang B, Wilkinson J, Beck J, Johnson T, Hall D, Chodosh J. Longitudinal, Interdisciplinary Home Visits vs. Usual Care for Homebound People with Advanced Parkinson's Disease (IN-HOME-PD): Study protocol for a controlled trial. JMIR Res Protoc 2021; 10:e31690. [PMID: 34238753 PMCID: PMC8479607 DOI: 10.2196/31690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 01/10/2023] Open
Abstract
Background The current understanding of advanced Parkinson disease (PD) and its treatment is largely based on data from outpatient visits. The most advanced and disabled individuals with PD are disconnected from both care and research. A previous pilot study among older, multimorbid patients with advanced PD demonstrated the feasibility of interdisciplinary home visits to reach the target population, improve care quality, and potentially avoid institutionalization. Objective The aim of this study protocol is to investigate whether interdisciplinary home visits can prevent a decline in quality of life of patients with PD and prevent worsening of caregiver strain. The protocol also explores whether program costs are offset by savings in health care utilization and institutionalization compared with usual care. Methods In this single-center, controlled trial, 65 patient-caregiver dyads affected by advanced PD (Hoehn and Yahr stages 3-5 and homebound) are recruited to receive quarterly interdisciplinary home visits over 1 year. The 1-year intervention is delivered by a nurse and a research coordinator, who travel to the home, and it is supported by a movement disorder specialist and social worker (both present by video). Each dyad is compared with age-, sex-, and Hoehn and Yahr stage–matched control dyads drawn from US participants in the longitudinal Parkinson’s Outcome Project registry. The primary outcome measure is the change in patient quality of life between baseline and 1 year. Secondary outcome measures include changes in Hoehn and Yahr stage, caregiver strain, self-reported fall frequency, emergency room visits, hospital admissions, and time to institutionalization or death. Intervention costs and changes in health care utilization will be analyzed in a budget impact analysis to explore the potential for model adaptation and dissemination. Results The protocol was funded in September 2017 and approved by the Rush Institutional Review Board in October 2017. Recruitment began in May 2018 and closed in November 2019 with 65 patient-caregiver dyads enrolled. All study visits have been completed, and analysis is underway. Conclusions To our knowledge, this is the first controlled trial to investigate the effects of interdisciplinary home visits among homebound individuals with advanced PD and their caregivers. This study also establishes a unique cohort of patients from whom we can study the natural course of advanced PD, its treatments, and unmet needs. Trial Registration ClinicalTrials.gov NCT03189459; http://clinicaltrials.gov/ct2/show/NCT03189459. International Registered Report Identifier (IRRID) PRR1-10.2196/31690
Collapse
Affiliation(s)
- Jori Fleisher
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Serena Hess
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Brianna Sennott
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Erica Myrick
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US.,Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, US
| | - Ellen Klostermann Wallace
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Jeanette Lee
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US.,Social Work and Community Health, Rush University Medical Center, Chicago, US
| | - Maya Sanghvi
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US.,Yale College, Yale University, New Haven, US
| | - Katheryn Woo
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, US
| | - Jayne Wilkinson
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, US.,Department of Neurology, University of Pennsylvania, Philadelphia, US
| | | | - Tricia Johnson
- Department of Health Systems Management, Rush University Medical Center, Chicago, US
| | - Deborah Hall
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison StreetSuite 755, Chicago, US
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, New York, US.,VA New York Harbor Healthcare System, New York, US
| |
Collapse
|
15
|
Sennott B, Woo K, Hess S, Mitchem D, Klostermann EC, Myrick E, Anderson S, Savica R, Fleisher JE. Novel Outreach Program and Practical Strategies for Patients with Parkinsonism in the COVID-19 Pandemic. JOURNAL OF PARKINSONS DISEASE 2020; 10:1383-1388. [PMID: 32804103 DOI: 10.3233/jpd-202156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has upended daily life and neurologic care for most patients, including those with Parkinson's disease and parkinsonism. Disruptions to routine care, high volumes of patient and caregiver calls, and our patients' risk of infection and complications inspired a proactive COVID-19 outreach program. This program targets patients with advanced Parkinson's disease and related disorders, specifically those who are homebound, receiving or eligible for palliative care, and/or lacking support networks. We describe the program and practical strategies providers can implement to support wellbeing and successful telehealth uptake during this time of social isolation and gradual reopening.
Collapse
Affiliation(s)
- Brianna Sennott
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Katheryn Woo
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Serena Hess
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Daniela Mitchem
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Ellen C Klostermann
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Erica Myrick
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sharlet Anderson
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jori E Fleisher
- Section of Movement Disorders, Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| |
Collapse
|