The rationale for improved integration between home care and neurology hospital services in patients with advanced Parkinson's disease.

Management of patients with advanced Parkinson's disease (PD) should benefit from improved integration between in-hospital services and home care. In Italy the number of PD hospital admissions is large but there are no guidelines of appropriateness to address queries of health authorities on resource allocation. Reasons for hospitalisation are often linked primarily to the occurrence of falls or infections leading to admission in internal medicine wards rather than neurology. This could be reduced if severe patients were provided with regular nursing and rehabilitation services at their homes and neurologists were actively involved in this process. Moreover, the application of infusion therapies (apomorphine or duodenal levodopa infusion) or deep brain stimulation would require integration with home care services after patient discharge. Here we propose a management algorithm that we believe would facilitate care and eventually lead to an optimisation of resource allocations for advanced PD patients. This would reduce unnecessary internal medicine hospitalisations and further highlight the role of neurologists as a key health care figure.