The Parkinson's Evening Group Clinic is geared towards multidisciplinary patient centred care, developing expert patient groups and addressing key unmet needs by allowing patients and their carers to access all members of the specialist multi-disciplinary team in one meeting. By utilising underused evening clinic space the clinic has reduced delays in the patient pathway. The group also allows patients and carers the opportunity to learn from each other by providing novel suggestion around how they manage some of the difficulties they have and what has worked well for them.
This example was originally submitted to demonstrate practice against NICE guideline CG35. The guideline has now been updated and replaced by NG71. The example has been reviewed and practice described remains consistent with the updated guideline.
Aims and objectives
The aim of the project was:
- To create a novel multidisciplinary evening group clinic for people with Parkinson's disease (PD).
- To give unique access to a multidisciplinary panel of experts.
- To ensure implementation of the NICE guidelines by addressing some of the key recommendations.
- To create an expert patient and carer group.
- To address key unmet needs such as non motor symptoms.
1) To provide expert review of diagnosis through rapid access to a specialist multidisciplinary team (MDT).
2) To develop an expert patient and carer group through open discussion and raise awareness of non motor problems.
3) To utilise evening clinic space and free up routine appointment slots for new patients entering the movement disorders clinic.
Reasons for implementing your project
As a national Parkinson Foundation centre of excellence, Kings College Hospital, movement disorders group, in addition to undertaking transitional and clinically based research, have also focused strongly on clinical national priorities on service delivery. Within this framework we have developed a group consultation clinic for patients with PD and their carers.
Prior to the implementation of the group clinic patients were being seen by each discipline separately during, the movement disorder clinic. Waiting times for follow up appointments were in breach of the NICE guidelines and threatened the implementation of the 18 week pathway for new patient slots. Choice of timing was limited as the clinic only ran on a Wednesday afternoon. Patients were only seen by the therapist if they identified a problem during their one to one session with their doctor and therefore there was no opportunity to discuss preventive measures such as falls reduction and the importance of exercise. The key element of the group is educational, to provide patients with reassurance and the right advice at the right time. For instance - access to leading edge drugs is a key issue for patients. However, not all patients will be suitable for a number of them, and the neurology pharmacist will explain to the patients why they may not be appropriate.
How did you implement the project
5 evening group clinics have been held with future evening clinics now planned for every two months. 74 patients and their caregivers have attended and have received expert review and access to a specialist MDT.
Feedback was positive, 43 people completed a feedback questionnaire of these respondents.
- 93% felt their expectation had been met.
- 96% of respondents felt their questions had been answered.
- 83% felt it satisfied their requirements for 1 to 1 consultation as well.
- 95% felt their understanding of PD had improved thus helping to develop an expert patient and carer group.
A total of 74 patient slots were freed up in the movement disorder one to one clinics this equates to approximately 3 weeks worth of clinics. As a direct result of this new patients and complex patients will wait 3 weeks less for a free appointment slot.
At the initial inception of the group clinic, no funding was available for staff time therefore the clinic was initially trialled on a good will basis. Once this proved successful a business case was put forward to secure the necessary funding. Funding has now been agreed for 6 clinics per year.
For the first clinics patients were booked in who had a Parkinsonian syndrome with associated dementia these patients were not suitable for a group clinic and disrupted the group dynamics. From this point the PD nurse specialist ensured only patients with a clear diagnosis of PD were offered group clinic appointments. Clear inclusion criteria for administration staff are vital for a successful clinic. In the future it is planned that each clinic will have a specific emphasis such as dyskinesias, hallucinations, and dysphagia.
Progress was monitored using feedback questionnaires at the end of each session. Patients and their carers were also asked to suggest topics for future clinics so that a rolling programme can be developed. We wish to collate data from future clinics and publish results in health service peer reviewed journals. Further investigation into whether attending such clinics can improve a patient self efficacy would be an area the team would like to investigate further. The MDT has met regularly to reflect on the clinic and discuss plans for future clinics.
74 patients and their caregivers attended the clinic. The majority brought at least one caregiver and on occasions more. As the clinic was an evening clinic there was more opportunity for friends and relatives who work to attend and gain an understanding of Parkinson's disease.
The patients who have attended the clinics have clearly benefited. The development of the group clinic also means that 74 patient slots have been freed up in the movement disorder one to one clinics this equates to approximately 3 weeks worth of clinics and therefore the implications of this is that new patients and complex patients who are not suitable for group clinics or choose not to attend a group clinic will wait 3 weeks less for a free appointment slot.
Key learning points
The patient selection is vital for a successful clinic. Patients with parkinsonian syndromes such as dementia with Lewy bodies or Cortical Basal degeneration may not be appropriate for this style of clinic. The patients need to be at broadly similar levels of disability. We wish to address this in future by developing more patient 'stage' centred clinics, with the possibility of clinics for early disease cases, later disease, post surgical etc.
Ensuring that there is appropriate funding, accommodation and audio visual equipment to provide the service is vital. Being sensitive and flexible to the group dynamics and allowing time for refreshments and discussion is an important component of the group.
Discussion of items brings up interesting and novel solutions from attendees that the professionals may not have considered. By having a rolling programme and ensuring that knowledge of their condition is developed to a point where they are empowered to take some responsibility for its management and work in partnership with their health and social care providers, patients can be given greater control over their lives.
On occasions team members have been approached at the end of the session for extra advice which can not be dealt with in a group setting e.g. adaptation to home environment. Further referrals have had to be made either to their local community teams or for a one to one session in the hospital. Therefore time needs to be allocated for these administrative tasks. Time is also required to prepare a variety of topics to present.
After the session patients and their GP's receive a letter detailing the clinic they attended and what topics were discussed. Any specific action points for the individual patient will also be documented in the letter.