Objective: To assess a multidisciplinary hospital day service for Parkinson’s disease and fall-related concerns, identify service gaps, and evaluate its 5-year impact.

Background: The Day Hospital Program, established in 2002, provides multidisciplinary care but faces COVID-19 disruptions, staffing shortages, and referral inefficiencies. Despite benefits, limited specialist input and suboptimal medication management reduce its impact, requiring improvements.

Method: A mixed-methods audit evaluated demographics, service use, clinical outcomes, and satisfaction, focusing on Timed Up and Go (TUG), Sit-to-Stand, 10-Meter Walk Test (10M WT), and speech function (Loud Ah test).

Results: The cohort (n=2,644, mean age 68, 53% female) had 29% falls/gait issues, 16% stroke, and 11% PD, with low specialist referrals <5%. Physiotherapy (47%) and occupational therapy (46%) were most accessed, with 21% dropout rate. Among PD patients (n=187, mean age 75, Hoehn & Yahr 2.63, table 1), mobility (+0.84s TUG, p=0.0041), strength (+1.34 Sit-to-Stand reps, p<0.001), and speech (+5.21 Loud Ah, p<0.001) improved (table 3), but cognitive and fine motor gains were minimal. Medication management was suboptimal, Levodopa with carbidopa is most prescribed in 55% and adjunct therapies underutilized (table 2). Patient feedback (n=10) showed high satisfaction with program structure, staff, and therapy benefits, particularly physiotherapy, falls management, and speech therapy. Carer meetings provided peer support, and the free taxi service improved accessibility. Participants suggested more medication education, alternative treatments, personalized home exercises, extended sessions, and greater scheduling flexibility (figure 1). One requested discussions on Voluntary Assisted Dying (VAD), highlighting the need for broader patient-centered discussions.

Conclusion: This audit confirms the benefits of a multidisciplinary day hospital for PD, improving mobility, strength, and speech but highlighting gaps in cognition, fine motor skills, and medication management. Low specialist referrals <5%, limited doctor consultations 22%, and a 21% dropout rate suggest care coordination issues. Planned interventions in 1 year aim to enhance specialist access, medication reviews, and referrals, with structured follow-ups to improve outcomes and efficiency.

Parkinson’s patients characteristics

Clinical outcomes (a)

Clinical outcomes (b)

List of medications

Patients survey

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MDS Abstracts - https://www.mdsabstracts.org/abstract/audit-of-a-multidisciplinary-day-hospital-for-parkinsons-and-falls-2019-2024/