Objective: To compare standards of care for patients with Parkinson’s disease (PD) between a general neurology clinic and specialist movement disorders clinic based on the United Kingdom National Institute of Health and Care Excellence (NICE) guidelines.

Background: It is unclear whether a specialist movement disorders clinic leads to better outcomes for PD patients compared to a general neurology clinic. There are no published studies from Ireland that investigate compliance with PD NICE guidelines.

Methods: Patients were selected from an established PD patient database for both clinics in Cork University Hospital. Outpatient clinic letters available on the hospital intranet were reviewed and the following parameters evaluated: diagnosis, medications, motor and non-motor complications and multidisciplinary input. Data was analyzed using Microsoft Excel.

Results: 79.5% (124/156) and 91.5% (86/94) of general and specialist clinics respectively have a diagnosis of idiopathic PD. The remaining patients either have another cause of parkinsonism (11.5% vs 7.5%) or turned out to not have parkinsonism at all (9% vs 1%). General clinic patients were older (mean age in years 81 vs 69) with a greater proportion in the complex and palliative phases combined (65% vs 39.5%). The specialist clinic demonstrated better outcomes with percentage reviewed at least once a year (71% vs 18%); percentage signposted to the PD Society (49% vs 3%) and documentation of driving status (84% vs 69%). Both clinics show near-perfect compliance with NICE guidelines regarding first line treatment options and similar proportions of motor and non-motor complications. However, access to a Parkinson’s nurse specialist is limited (none from general clinic, 3.5% from specialist clinic). Diagnostic utilisation of levodopa challenge (3.2% vs 1.2%) and DAT scan (8% vs 9.3%) was similar in general and specialist clinics respectively.

Conclusions: There is a tendency for new patients with suspected PD to be triaged into a specialist rather than general clinic. Both clinics demonstrate similar caseload in terms of clinical complexities of patients seen, as well as largely similar diagnostic and management practices. Resources should be invested into the availability of PD nurse specialist input and increasing number of clinic slots to maximise the full potential of PD care.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-comparison-of-standards-of-care-in-parkinsons-disease-between-a-general-neurology-clinic-and-a-specialist-movement-disorders-clinic-based-on-the-uk-nice-guidelines/