There is a growing awareness that delivery of integrated and personalized care is necessary to meet the needs of persons living with Parkinson’s disease. In other chronic diseases than Parkinson’s disease, care management models have been deployed to deliver integrated and personalized care, yielding positive effects on patients’ health outcomes, quality of life and health care utilization. However, care management models have been highly heterogeneous, as there is currently no clear operationalization of its core elements. In addition, most care management models are disease-specific and not tailored to the individual needs and preferences of a patient. In this viewpoint we present an integrated and personalized care management model for persons with Parkinson’s disease costing of five core elements: (1) care coordination, (2) patient navigation, (3) information provision, (4) early detection of signs and symptoms through proactive monitoring and (5) process monitoring. Following the description of each core element, implications for implementing the model into practice are discussed. Finally, we provide clinical and methodological considerations on the evaluation of care management models.

Background Culminating evidence shows that current care does not optimally meet the needs of persons with parkinsonism, their carers and healthcare professionals. Recently, a new model of care was developed to address the limitations of usual care: Proactive and Integrated Management and Empowerment in Parkinson’s Disease (PRIME Parkinson). From 2021 onwards, PRIME Parkinson care will replace usual care in a well-defined region in The Netherlands. The utility of PRIME Parkinson care will be evaluated on a single primary endpoint (parkinsonism-related complications), which reflects the health of people with parkinsonism. Furthermore, several secondary endpoints will be measured for four dimensions: health, patient and carer experience, healthcare professional experience, and cost of healthcare. The reference will be usual care, which will be continued in other regions in The Netherlands. Methods This is a prospective observational study which will run from January 1, 2020 until December 31, 2023. Before the new model of care will replace the usual care in the PRIME Parkinson care region all baseline assessments will take place. Outcomes will be informed by two data sources. We will use healthcare claims-based data to evaluate the primary endpoint, and costs of healthcare, in all persons with parkinsonism receiving PRIME Parkinson care (estimated number: 2,000) and all persons with parkinsonism receiving usual care in the other parts of The Netherlands (estimated number: 48,000). We will also evaluate secondary endpoints by performing annual questionnaire-based assessments. These assessments will be administered to a subsample across both regions (estimated numbers: 1,200 persons with parkinsonism, 600 carers and 250 healthcare professionals). Discussion This prospective cohort study will evaluate the utility of a novel integrated model of care for persons with parkinsonism in The Netherlands. We anticipate that the results of this study will also provide insight for the delivery of care to persons with parkinsonism in other regions and may inform the design of a similar model for other chronic health conditions.

Poor recognition and inadequate treatment of motor and non-motor symptoms negatively impact on the quality of life of persons with Parkinson's Disease (PD). Furthermore, failure to incorporate timely detection and management of symptoms increases the risk of partially avoidable complications. A promising approach to overcome these pitfalls is telenursing, which entails proactive care delivery by a PD Nurse Specialist (PDNS) through telephone contacts. We hypothesized that adding telenursing to usual care could fill a gap in currently available services, including offering patients easy accessibility to a nurse with specific expertise in PD. We explored this hypothesis by prospectively assessing the effects of a telenursing intervention on motor and non-motor symptoms in a patient with PD. During a threemonth intervention period which comprised 13 telephone contacts, the patient reported a remarkable reduction in number of falls, from 99 falls per three months to 3 falls per three months; and a reduction in non-motor symptoms. The main working mechanism was presumably rather indirect and mediated via alleviation of anxiety, achieved by the individually tailored information and problem-solving strategies provided by the PDNS. Our observations should encourage large-scale evaluations to assess the long-term effectiveness and cost-effectiveness of telenursing interventions in persons with PD.

The impact of sex and gender on disease incidence, progression, and provision of care has gained increasing attention in many areas of medicine. Biological factors-sex-and sociocultural and behavioral factors-gender-greatly impact on health and disease. While sex can modulate disease progression and response to therapy, gender can influence patient-provider communication, non-pharmacological disease management, and need for assistance. Sex and gender issues are especially relevant in chronic progressive diseases, such as Parkinson's disease (PD), because affected patients require multidisciplinary care for prolonged periods of time. In this perspective paper, we draw from evidence in the field of PD and various other areas of medicine to address how sex and gender could impact PD care provision. We highlight examples for which differences have been reported and formulate research topics and considerations on how to optimize the multidisciplinary care of persons with PD.

Objective We sought to systematically examine the effectiveness of case management interventions on common and potentially preventable complications associated with Parkinson’s disease, both in persons with Parkinson’s disease and in persons with other chronic health conditions. We specifically focused on falls, depression, anxiety, hallucinations, urinary tract infections and swallowing impairments. Background There is no systematic insight in the effect of case management on common complications associated with Parkinson’s disease. This is an important knowledge gap given that people living with Parkinson's have identified care coordination as one of their highest priorities. Furthermore, it remains unclear whether the putative beneficial effects of case management would vary by key patient characteristics, such as their age, gender or disease characteristics. Such insights would contribute to a shift from “one size fits all” healthcare resource allocation to personalized medicine. Methods Using predefined inclusion criteria, we identified studies published up till February 2021 from PubMed and Embase databases. For each study, data were extracted independently by two researchers. Narrative analysis, and when possible also meta-analysis and random-effects analyses were undertaken. Results 23 randomized controlled trials and four non-randomized studies reported data on the effect of case management on feelings of anxiety (8 studies) or symptoms of depression (26 studies). Only one study was conducted in people with Parkinson’s disease. No study were identified that reported on how case management affected falls, hallucinations, urinary tract infections or swallowing impairments. Across meta-analyses, we observed a statistically significant effect of case management on reducing anxiety (Standardized Mean Difference [SMD] = − 0.47; 95% confidence interval [CI]: -0.69, -0.32) and depression (SMD = − 0.48; CI: -0.71, -0.25). We found a large heterogeneity in effect estimates across studies, but this was not explained by patient population or intervention characteristics. Conclusions Among people with chronic health conditions, case management has beneficial effects on symptoms of depression and feelings of anxiety, which are two common complications of Parkinson’s disease. However, these findings were based almost exclusively on interventions in people with other diseases. Future studies should assess the utility of case management for preventing complications in people with Parkinson’s disease, with a particular focus on the optimal content, frequency, and intensity of case management.