In this video, Keschey Marcelle, Clinical Nurse Specialist, Integrated Movement Disorders Clinic, Toronto Rehabilitation Institute, Toronto, Ontario, reviews research presented in a poster at MDS Virtual Congress 2021 titled “Nurse-led rapid access mental health clinic: a new care pathway in Parkinson's disease.”

Mental health is a common issue in Parkinson disease, and access to support can be limited due to wait times and expense. Marcelle et al piloted a clinic for the assessment and non-pharmacological management of mental health symptoms performed by nurse practitioners on patients with Parkinson disease.

Read the Transcript:

Keschey Marcelle:  Hi. My name is Keschey Marcelle. I am a clinical nurse specialist. This is a recap for the MDS poster on nurse-led rapid access mental health clinic, a new care pathway to Parkinson disease.

I am affiliated with the Movement Disorder Clinic in the Toronto Western Hospital in U of T, the University of Toronto, and the Integrated Movement Disorder Program at Toronto Rehabilitation Institute in Toronto, Ontario.

Mental health is a common problem in Parkinson disease and access to support is very limited. It's limited by long wait time to see psychiatry and the very high out-of-pocket expense for psychotherapy. We know that over 40 percent of patients experience depression, anxiety, apathy, grief, and coping difficulty.

Focus assessment and non-pharmacological management of these symptoms are within the scope of our nurse with mental health training. We set out to provide a rapid evaluation and non-pharmacological treatment of mental health symptoms for patients with Parkinson disease and for their care partners.

We piloted a clinic that ran for a year, but the poster presented for eight months, which was from September to April, September of 2020 to April of 2021, at the Toronto Western Hospital Movement Disorder Clinic.

Any patient with mental health symptoms were eligible. They were referred by the neurologist from the clinic. They had a virtual intake assessment where they had focused history, education, and some local resource finding. Then they had a follow-up appointment that was offered.

Prior to that virtual evaluation, that intake assessment, they completed the Beck Anxiety Inventory, the Beck Depression, and the PDQ-39. A month later, they did the same thing post. Outcome measures included a clinical matrix, patient satisfaction, and qualitative process measure. That was represented in Table 1.

The results that was represented on the poster is that we saw 46 patients. A little over 50% of them were male over the 8 months that we saw patients. About 69 visits were conducted on average about a month before patients were seen. Sixty percent of our patients had preexisting psychiatric diagnosis.

Common reasons for referral were anxiety, uncertainty with the disease trajectory, COVID-19 stress, fluctuation in their mood were among the common chief complaints. Other common concerns were a lack of reliable education around Parkinson disease and that care partners, their role felt quite neglected as part of the care team.

Intervention, which was represented in Figure 2, included a lot of symptom validation and normalization, Parkinson education, body relaxation techniques, caregiver support, recommendations for psychotherapy.

Figure 2 listed some of the other supports, which included things like the drop-in clinic, community resources, psychotherapy, referral to the psychiatry. Some of the feedback that we got was a high percentage of our patients were satisfied and patients requested to have a follow-up appointment. There was a high need for local resource finding.

What we came out of it realizing is that the rapid access mental health clinic is feasible and effective in patient-centered care pathway to mild to moderate stage of Parkinson disease for Parkinson disease patients.

Patients benefited from a focused mental health evaluation and appreciated the non-pharmacological treatment strategies. A small percentage of patients needed referral to see the psychiatrist. Which suggested that this model may be cost effective in avoiding psychiatric referrals.

We realized that resource finding was labor intensive and that in the future, we may need to look at a collaborative model where teaming up with social work may be beneficial.

This model were conducted entirely virtually, which helped to improve quality of care and access.

Moving forward, research may look to focus on clinical efficacy of this model of care and the economic benefit of this model of care for Parkinson disease.