Improving Quality of Movement Disorder Care for Nursing Home Residents

Introduction

Within the Older Person’s Medicine Movement Disorder service at Newcastle upon Tyne Hospitals, we were aware people with Parkinson's (PWP) living in nursing care were not necessarily receiving the same quality of care as other PWP. We have developed a nursing home movement disorder clinic to address this.

Methods

Practically, approximately 15% of PWP were identified as living in nursing care. After review of the geography and numbers, one consultant and specialist nurse clinic were allocated a month to facilitate care home visits to all PWP within 6 months.

After identifying PWP living in nursing care, we reviewed the case notes for a randomly selected third of the nursing home residents and an equal number of those not living in nursing care, to assess any difference in care. This has been repeated following our first 6-month cycle of clinics, with PWP and family feedback being gathered.

Results

There was a clear difference between the two groups in the initial review with less detail symptom reviews taking place for those in nursing care, and heavy reliance on telephone reviews. This corresponded with fewer recommendations for changes in medications and less involvement of the multidisciplinary team. Following 6 months of care home visits, the reviews have been more detailed across both motor and non-motor domains. This has corresponded with a small increase in MDT referrals and recommendations for changes to medications, both for motor symptoms and more widely. The feedback from PWP and relatives has been universally positive, with appreciation of removing the physical barrier to specialist review.

Conclusion

PWP in nursing care benefit and appreciate in person review, and practically we can deliver this within our service. We are aware there is likely to be an unmet need within our corresponding neurology service to explore.