Moving towards home-based community-centred integrated care in Parkinson's disease
Moving towards home-based community-centred integrated care in Parkinson's disease
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DOI：
10.1016/j.parkreldis.2020.07.001
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发表时间：
2020-09-01
影响因子：
4.1
通讯作者：
Ferreira, Joaquim J.
中科院分区：
文献类型：
--
作者：
Fabbri, Margherita;Caldas, Ana Castro;Ferreira, Joaquim J.
帕金森氏病（PwP）患者会经历各种运动和非运动症状，这些症状与日益增加的护理复杂性有关。一个多专业的方法已经提出了一个直观的解决方案，为定制和全面的护理服务。尽管如此，过去的多学科或跨学科护理模式在PD中的试验表明，生活质量（QoL）的小益处没有可测量的变化，并且未能显示经济可持续性。我们提出了一个以家庭为基础的社区为中心的综合护理（iCARE-PD）的PwP作为一个务实的解决方案，利用现有的护理资源的潜力，使用综合护理策略，使自我管理的支持和实施技术支持的护理。iCARE-PD模型基于Freeman的护理连续性概念和扩展的慢性病护理模型，用于组织护理策略。以家庭为基础、以社区为中心的综合护理对临床实践有直接影响，通过优化成本增加获得护理的机会，可能会给农村地区或低收入国家带来好处。有必要确定哪些干预措施以及如何在每个地方部署iCARE-PD模型时用作护理工具。我们提出了一个多学科的框架，以产生证据支持其实施的标准护理在未来和划定的核心战略，以确保这种护理方法在不同的医疗保健系统的实施，以确保可行性和经济的可持续性。我们设想这种模式成为一种可转移到非典型形式的神经退行性帕金森症患者的个性化护理模式。
People living with Parkinson's disease (PwP) experience a wide range of motor and non-motor symptoms associated with increasing complexity of care delivery. A multispecialty approach has been presented as an intuitive solution for tailored and comprehensive care delivery. Nevertheless, past trials of both multidisciplinary or interdisciplinary care models in PD suggested no measurable change to a small benefit in quality of life (QoL) and failed to show economic sustainability. We propose a home-based community-centred integrated care (iCARE-PD) for PwP as a pragmatic solution to harness the potential of existing care resources using an integrated care strategy, enable self-management support and implement technology-enabled care. The iCARE-PD model is based on Freeman's concept of continuity of care and the expanded Chronic Care Model for organization of care strategies. A home-based community-centred integrated care has immediate implications for clinical practice, with potential benefits in rural areas or lower-income countries, by enhancing access to care with optimized costs. There is a need to establish which and how interventions may be used as an instrument of care in each local deployment of the iCARE-PD model. We put forward a multidisciplinary framework to generate the evidence supportive of its implementation as the standard of care in the future and delineate the core strategies to secure the implementation of this care approach across different health care systems to ensure feasibility and economic sustainability. We envision this model becoming a paradigm of personalized care transferable to people with atypical forms of neurodegenerative parkinsonism.