Objective: To evaluate the acceptability, feasibility, safety and effectiveness of a novel remotely delivered Parkinson’s care pathway.

Background: Current care pathways for people with Parkinson’s (PwP) are not tailored to individual need.  At University Hospitals Plymouth NHS Trust, UK, we have implemented a novel Parkinson’s care pathway, co-designed with PwP, Home-Based Care (HBC). HBC provides personalised care through supported self-management, triggered contacts and digitally-enabled remote monitoring. Here we have evaluated acceptability, feasibility, safety, and effectiveness.

Method: Evaluation was performed at baseline and 6-months of motor (UPDRS II and accelerometer) and non-motor (NMSQ, PDSS2, HADS) symptoms, acceptability and self-management efficacy. Care was audited against Parkinson’s UK national audit standards. Process measures captured feasibility. Safety was assessed via triggered contacts and questionnaire completion/return rates. Carer and patient experience was evaluated by framework analysis of transcripts from semi-structured interviews. Staff wellbeing was assessed using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS).

Results: From Oct 2019 to January 2021, 111 PwP were enrolled onto HBC; data are available from 111 patients at baseline and 53 at 6m. Overall, over 90% of all questionnaires were returned, 97% being complete or having no more than 2 missing items. Reporting and communications occurred within the timeframes agreed with patients. Compared with baseline, after 6m on HBC, fewer PwP had severe non-motor symptom burden (33% vs 51%), depression (3% vs 9%) and anxiety (10% vs 19%); median UPDRS II improved from 12.0 to 9.0; more PwP had controlled bradykinesia (22% vs 30%); PwP felt more involved in care (59% vs 41%), listened to (63% vs 47%) and treated as an individual (71% vs 57%), as well as having increased PD understanding (47% vs 40%). HBC met 93% of national audit criteria. There was a significant improvement in staff wellbeing, with a mean improvement of 9.8% in WEMWBS score (n=8).  Key themes from the interviews included increased feelings of autonomy for PwP, and empowerment for carers, encouraging a pro-active approach to symptom management.

Conclusion: We have demonstrated acceptability, feasibility and effectiveness of our novel remotely-delivered Parkinson’s care pathway, with benefits for PwP and staff involved in their care.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/evaluating-a-novel-home-based-care-pathway-for-people-with-parkinsons-disease/