Infrastructure And Human Resources

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

Early stages

Preserved autonomy and independence May retain job

Intermediate stages

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)

Advanced stages

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)

Deglutition disorders

End stage disease

Institutionalization as a last resort

Major disability, patient may become bedridden or need significant degree of assistance (feeding tube, gastrostomy)

Was this article helpful?

0 0

Post a comment