Objective: To explore a new model of integrated patient-centered care based on telemedicine (‘Telenursing’) for home management through a Case Manager aiming to improve PwP/caregivers quality of life by:

optimizing management of motor/non-motor symptoms;

supervising medication compliance to minimize side effects;

minimizing complications and unscheduled hospital admissions/visits (reducing direct/indirect costs for the NHS).

Background: Persons with Parkinson’s disease, atypical or secondary parkinsonism (PwP) experience a wide range of symptoms and complications that are associated with increasing disability and complexity of care delivery. An integrated approach, involving a PwP nurse specialist (Case Manager), could offer benefits to PwP and caregivers.[1,2]

Method: From the COVID-19 pandemic, fragile PwP with motor and/or nonmotor disability are followed remotely by a ‘digital’ case manager by telephone (3 hours/day, 5 days/week) or email.[3] Interventions are both ‘Reactive’ (on-demand) and ‘Proactive’ (regular active follow-up, ranging from 1-week to 3-month).

The Case Manager managed and resolved medical issues (a) independently; (b) interacting with the neurologist; (c) interacting with a multidisciplinary team (physiatrist, psychologist, gastroenterologist, GP, etc.).

Results: Awaiting the results of two ongoing multicentre clinical trials (NCT05273957, NCT05792332), we report the experience gained at our Institute over the last 3 years.

From 25/11/2020 to 31/10/2023, 898 PwP have been included and followed-up.

The Case Manager managed a total of 1739 interventions (‘Reactive’ or ‘Proactive’) based on PwP and/or caregiver requests, of which:

– 52% resolved independently

– 20% resolved after discussing with the treating neurologist

– 17% managed involving the multidisciplinary team

– 11% required the neurologist intervention (email, telephone, televisit, in-person visit).

Conclusion: The Case Manager managed almost 90% of PwP medical issues, substantially reducing the neurologist’s intervention to a few well-selected cases. This model is highly innovative and has the potential to change the management of patients with parkinsonism in routine clinical practice.

References: [1] Lennaerts H, et al. A Guideline for Parkinson’s Disease Nurse Specialists, with Recommendations for Clinical Practice. J Parkinsons Dis. 2017;7(4):749-754.
[2] van der Marck MA, et al. Effectiveness of multidisciplinary care for Parkinson’s disease: a randomized, controlled trial. Mov Disord 2013;28:605–11.
[3] Cilia R, Mancini F, Bloem BR, Eleopra R. Telemedicine for parkinsonism: A two-step model based on the COVID-19 experience in Milan, Italy. Parkinsonism Relat Disord. 2020;75:130-132.

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