The path to specialist multidisciplinary care in amyotrophic lateral sclerosis: A population-based study of consultations, interventions and costs
The path to specialist multidisciplinary care in amyotrophic lateral sclerosis: A population-based study of consultations, interventions and costs
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DOI：
10.1371/journal.pone.0179796
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发表时间：
2017-06-22
期刊：
影响因子：
3.7
通讯作者：
Hardiman, Orla
中科院分区：
文献类型：
--
作者：
Galvin, Miriam;Ryan, Padhraig;Hardiman, Orla
肌萎缩侧索硬化症（ALS）是一种严重的神经系统疾病，需要多学科的临床治疗. ALS是容易误诊为它的体征和症状可能是非特异性的，这可能会延长患者的旅程多学科ALS care.MethodsUsing图表审查和国家登记数据，我们详细介绍了旅程的ALS患者（n = 155）的国家队列的时间从第一个症状到介绍在多学科诊所（MDC）。关键里程碑进行了分析，包括频率的咨询，临床干预，和相关的economic costs.ResultsA大多数患者是男性（60%），65岁及以上（54%），并有脊髓发病ALS（72%）。从首次出现症状到ALS诊断的时间平均为15.1个月（中位数为11个月）。从首次出现症状到到达MDC的平均间隔时间为17.4个月（中位数为12.5），平均4.09次（中位数为4次）与卫生保健专业人员的协商。肌电图和神经传导研究是最常见的干预措施。由全科医生（GP）直接转诊到神经科医生与降低成本，但没有减少诊断延迟。延髓型ALS与从症状发作到诊断的时间较短相关。在前三次咨询中，神经科医生咨询与ALS诊所就诊前的较低费用相关，但从首次症状到最终诊断的时间并不短。参加MDC之前的平均成本是（原文如此）3,486 personalpatient.ConclusionsExpedited转诊到多学科ALS诊所将减少成本的估计（原文如此）2,072每例患者。制定一个标准化的路径，早期转诊到神经科的患者疑似症状的ALS可以限制不必要的干预和降低护理成本。
BackgroundAmyotrophic Lateral Sclerosis (ALS) is a devastating neurological condition that requires coordinated, multidisciplinary clinical management. ALS is prone to misdiagnosis as its signs and symptoms may be non-specific, which may prolong patients' journey to multidisciplinary ALS care.MethodsUsing chart review and national register data, we have detailed the journey of a national cohort of ALS patients (n = 155) from the time of first symptom to presentation at a multidisciplinary clinic (MDC). Key milestones were analysed, including frequency of consultations, clinical interventions, and associated economic cost.ResultsA majority of patients was male (60%), 65 years of age and over (54%), and had spinal onset ALS (72%). Time from onset of first symptoms to ALS diagnosis was a mean of 15.1 months (median, 11). There was a mean interval of 17.4 months (median 12.5) from first symptoms to arrival at the MDC, and a mean of 4.09 (median, 4) consultations with health care professionals. Electromyography and nerve conduction studies were among the most common interventions. Direct referral by a general practitioner (GP) to a neurologist was associated with reduced cost, but not reduced diagnostic delay. Bulbar ALS was associated with shorter time from symptom onset to diagnosis. Neurologist consultation in the first three consultations was associated with lower costs prior to the ALS clinic attendance but not a shorter time from first symptom to final diagnosis. Mean cost prior to attending the MDC was (sic)3,486 per patient.ConclusionsExpedited referral to the multidisciplinary ALS clinic would have reduced costs by an estimated (sic)2,072 per patient. Development of a standardised pathway with early referral to neurology of patients with suspected symptoms of ALS could limit unnecessary interventions and reduce cost of care.