As the disease runs a progressive course going through different stages with changing needs according to each stage, the need for infrastructure and the involvement of human resources varies accordingly. Figure 3.8.2 provides an algorithm on health systems requirement as the disease progresses.
Special mention has to be made of the demand for human resources and infrastructure in the case of patients in whom pharmacological manipulations fail to modify long-term motor complications and who are considered candidates for stereotactic surgery (both lesional or deep-brain stimulation). Although the percentage of patients requiring these procedures is still small, the demand will probably grow until better pharmacological options are available. The cost of these procedures is quite high and the need for specialized personnel, infrastructure, and equipment is significant.
Figure 3.8.2 Progression of Parkinson's disease and health system requirements
Periodic medical controls
Outpatient clinic, may be managed by non-specialist
Treatment requirements simple
Preserved autonomy and independence May retain job
More frequent medical control required
May need specialized care
Treatment requirements more complex (physical and speech therapy, in some cases surgery)
Motor impairment and disability more evident
Motor complications (fluctuations and dyskinesias)
May require hospital admissions and participation of other medical specialties (urologist, clinician, gastroenterologist, orthopaedist, psychiatrist; specialized nurses, social workers)
May require PD surgery
More pronounced motor complications, non motor complications
(urinary, autonomic, cognitive impairment, falls)
End stage disease
Institutionalization as a last resort
Major disability, patient may become bedridden or need significant degree of assistance (feeding tube, gastrostomy)
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