Patient-centred management of Parkinson's disease.

The Personal View by Bloem and colleagues on integrated and patient-centred management of Parkinson's disease proposes a health system organisation to address complex care in chronic neurological disorders, using Parkinson's disease as an example. The proposed hub-and-spoke model envisions the integration of health professionals based on a Parkinson's disease centre of excellence integrated with community hospitals. We share the values put forward as pillars for a framework change in the care of Parkinson's disease and other chronic neurological diseases but would like to offer additional insights for their wider dissemination and implementation.

As mentioned by Bloem and colleagues, it is necessary to adapt any model of integrated health care to local circumstances. However, how the different components of the model might be implemented is unclear and, in our opinion, the most crucial barrier for the effective use of comprehensive care in Parkinson's disease management.

For example, Bloem and colleagues make Parkinson's disease specific training of allied health professionals a fundamental piece of the model. Although we agree with the need for training, this ideal scenario could be impractical in many health-care environments. The infrastructure needed for training these professionals is substantial and highly trained health professionals could become quickly overwhelmed with patients.

To overcome the practical limitations of multispecialty care for Parkinson's disease, we propose a regional care network that starts by optimising existing allied health programmes and community resources (including primary care physicians) and allows for self-management. We believe this approach would enable implementation of care integration in most health-care models and could be a cost-effective alternative with positive outcomes. We envision a toolkit to guide the application of these care principles to local care settings. Its development requires a multinational, multidisciplinary effort with health-care teams, clinical researchers, health economists, and sociologists. Patient-centredness is paramount to fulfil this vision, and co-designed methodologies should be a framework to develop a care model tailored to patient needs at disease onset and beyond.3, 4

The COVID-19 pandemic has prompted a change in care delivery with increased uptake of telemedicine and online care resources. It is fundamental to address the question of what the most beneficial and feasible care delivery model is and, consequently, if Parkinson's disease tertiary centres should remain the hub of care. The current scenario is an opportunity to test the hypothesis that a major component of Parkinson's disease care has shifted to the home and community and that any care model must be pragmatic and tailored to the patient's needs. Pragmatism is key in delivering chronic neurological care.