Clinic Review of Pd Patients
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CLINIC REVIEW OF PD PATIENTS Dr Georgios Aperis, Consultant Geriatrician, Southmead Hospital Bristol In November 2017 while I was working as a Consultant Geriatrician in Queen Alexandra Hospital, Portsmouth I was asked to take over the Parkinson’s disease clinic in St. Mary’s hospital for a period of 9 months in order to cover a consultant on maternity leave. I was interested in PD for many years but, I had never had the opportunity to review them in clinic. I usually reviewed them when they were admitted into hospital for other reasons rather than the PD. I noticed that, in many instances the patients or the families had still questions about the disease and also they did not know what is more of less important when we review PD in clinic. Moreover, in some occasions they were not happy that the doctor did not have much time to answer the questions they had. For the above reasons, I decided to develop a tool for the clinic review of PD and to assess this tool by asking for a patient feedback. I wished to use an already validated tool for patient’s feedback. Patients and methods I did not intend to do a scientific work or an audit, but to review the motor and non-motor symptoms of PD. I wished to use a validated patient feedback form to assess my consultation skills. There were time and organisational limitations and I could not repeat the questionnaire to ensure I maintained the results of the first one. I used the GMC suggested questionnaire of patient feedback. This is known to all doctors and is the one we use for our revalidation every five years. I excluded patients with significant dementia or significantly reduced hand dexterity that could not fill in the questionnaire, unless they had a NOK with them. I included new as well as review patients, although almost all patients were new to me. The data collection was anonymous. I recorded separately the age, sex as well as the duration of the consultation. I did not include the numbers of patients that came from NH or RH who attended with a carer if the patient was unable to fill in the questionnaire. I did not include co-morbidities. I included only patients attending St. Mary’s hospital. Patients from the area who attend Havant, Gosport, Cosham, Petersfield and Southampton were not included. The choice was otherwise random. In St. Mary’s Hospital the time of clinic attendance is 20 minutes for the reviews and 45 minutes for the new patients. This includes nursing assessment with BP on lying, as well as 1and 3 minutes of standing, ECG, AMTS and or MOCA once a year and history. The consultation consisted the following (Table 1): Non Motor Assessment 1. Neuropsychiatric (cognition, hallucinations, mood, anxiety), 2. Speech and swallow (communication, swallow, drooling), 3. Pain, 4. Postural BP, 5. Nutrition/Weight, 6.Sleep disorder/Daytime sleepiness Motor and ADL assessments: 1. Mobility (On-off, gait/freezing, falls/balance, tremor, 2. Function (bed mobility, transfers, dressing, hygiene, cutlery, domestic chores, driving) Bone health Table 1. Non motor symptoms 1. Neuropsychiatric Cognition, hallucinations, mood, anxiety 1. Speech and swallow Communication, swallow, drooling 1. Pain 1. Postural BP 2. Nutrition/weight 3. Sleep disorders/daytime sleepiness Motor and ADL assessments 1. Mobility On/off phenomena, freezing, falls, balance, tremor 1. Function Bed mobility, transfers, dressing, hygiene, cutlery, domestic chores, driving Bone health Results Forty six patients participated in the project. Twenty eight (28) were male and eighteen (18) female. Ten percent (10%) was new patients and 90% were reviews. The average age was 76.73 (65-92 years). The responses to the questions were the following (in some occasions there were more than one responses): 1. Are you filling the questionnaire for Patients 26 Spouse/Partner 13 Other relative 7 2. Reasons for seeing doctor Advice 2 Ongoing problem 32 Treatment 8 Routine check 15 Follow up 1 Not answered 4 3. Consultation First Part A. Being polite Good 7, Very good 39 B. Making you feel at ease Good 7, Very good 39 C. Listening to you Good 7, Very Good 38, Not answered 1 D. Assessing your medical condition Good 8, Very good 37, Not answered 1 E. Explaining your condition/treatment Good 8, Very good 37, Not answered 1 F. Involving you in decisions about your treatment, Satisfactory 1, Good 9, Very good 35, Not answered 1 G. Providing and arranging treatment for you Good 8, Very good 34, Does not apply 3, Not answered 1 4. Consultation Second Part A. Confidentiality, Neutral 2, Agree 14, Strongly agree 29, Not answered 1 B. Doctor honest and trustworthy, Agree 14, Strongly agree 29, Not answered 3 C. Confidence about doctor’s ability to provide care, Yes 46, No 0 D. I will be happy to see this doctor again, Yes 46, No 0 E. Was this your usual doctor Yes 6, No 38, Not answered 2 F. Nationality British 31, Irish 1, Indian 1, Iranian 1, Not answered 12 The results can be seen in the following Table 2: Table 2. Comments The discrepancy between the male to female ratio and the age discrepancy can be explained because in 20 patients the NOK filled in the questionnaire and records his or her age and sex and not the patient’s!!!!! Conclusion This structured review is effective and patients are satisfied. It addresses the most important parameters and not only the motor symptoms. Establishes good rapport with patients we will review for many years thus the doctor-patient relationship is important The downside is it is time consuming and the last two patients of the day had to wait around for 53- 112 minutes A way to improve this is the ongoing use and also for the patients that visit us twice a year to do it in alternate clinic reviews .