Objective: To present the design and implementation of a proposed solution to handle tertiary-care evaluations for patients with tremor; providing comprehensive recommendations effectively communicated to referring providers.

Background: Clinically differentiating between the most common tremor phenomenologies can be difficult. Tremor in ET and PD are often rendered medically-refractory within as little as 1 year of initiating pharmacotherapies on the market, leading to frustration among patients and treating providers when knowledge of other available interventions is lacking. Tertiary care centers can often offer asynchronous subspecialty services, but effective collaborative models of care have not been clearly created nor their utility defined.

Method: A consultative approach to offering evaluations for patients of any tremor type was implemented at the University of North Carolina at Chapel Hill. Qualifying patients to the Tremor Interdisciplinary Clinic (TIC) are sent a survey to understand their goals, then scheduled to receive a one-hour evaluation each by: a movement disorders specialist, functional neurosurgeon, and occupational therapist. A fourth hour involves a visit with a biomedical engineer who measures tremor characteristics; research coordinator who gauges interest and eligibility for available trials; and nurse who can provide real-time care coordination. The team meets for one hour to discuss 4 cases, providing a collaborative set of medical, conservative, and surgical considerations summarized in writing for patients and their referring providers.

Results: To date, the TIC is held monthly. We will present pre-visit survey data on participants’ prioritized goals, demographic information, post-visit surveys of their experience with the TIC, and survey data from referring providers regarding the service and change in self-perceived competency managing tremor after receiving personalized recommendations.

Conclusion: We propose that the TIC consultative yet collaborative model of offering interdisciplinary tremor evaluation and management recommendations may better fill a need to optimize care for this large patient population who otherwise might never establish with a movement disorders center.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/proposed-model-for-the-delivery-of-tertiary-care-interdisciplinary-tremor-evaluations/