Experiences implementing an integrated motor neurone disease multidisciplinary clinic to address unmet complex needs in a regional centre

Background: Person-centred care (PCC), integrated care and access to specialised motor neurone disease (MND) multidisciplinary clinics (MDC) are optimal approaches to the delivery of quality service for people living with MND (plwMND) for improved quality of life and care experiences [1-3]. Since the changes in service delivery and aged-based funding models in Australia (My Aged Care and National Disability Insurance Scheme (NDIS)), collaborative interdisciplinary working practices, and connected and coordinated cross sector care for plwMND, have been impacted.

Aim: To address the unmet need for coordinated and connected PCC across health, disability, and aged care sectors, and support research opportunities, through the development of a specialist MND MDC in a regional area.
Clinic development and practice
The MND MDC was developed and implemented by a team of health care professionals (HCP) with expertise in MND, includes a neurologist (clinic lead), speech pathologist, occupational therapist, physiotherapist, dietician, MND advisor and NDIS coordinator of support, and rehabilitation, palliative care, and respiratory specialists. Each plwMND is assessed and then participates in discussions on their health and social care needs. Afterwards a case conference is held to discuss individual needs, including making appropriate referrals. MDC review and recommendations are communicated to plwMND, their GP and treating team, through a written report.

Clinic preliminary findings: The inaugural clinic was held in February 2020, with a total of four MDCs held to date. A total of 14 plwMND have attended the MDCs, aged between 40 and 84 years. Ten out of the 14 attendees were male. Attendance to MDC ranged from all 4 clinics (1), 3 clinics (1), 2 clinics (5), and 1 clinic (7). PlwMND attending received funding from the NDIS (6), My Aged care (6), Veterans Affairs (1), and no funding (1). Implementation of the MDC has been enabled through building a strong team and partnerships, access to clinic space, administration support, engagement with plwMND and their families, and access to technology. The limited engagement by public health, impact of sector and funding silos, and limited options for reimbursement of service are barriers to collaborative practices and sustainability of the MDC.

Conclusion: Despite the disconnect of care provision and inequitable funding structures across health, disability and aged care sectors which threatens PCC, this MDC attempts to address fragmentation of care for all plwMND, irrespective of age, and foster collaborative and integrated care practices across sectors and organisations. Further findings will be presented.

References:
1.Aoun, S., A. Hogden, and L. Kho, Until there is a cure, there is care”: A person-centered approach to supporting the wellbeing of people with Motor Neurone Disease and their family carers. European Journal for Person Centered Healthcare, 2018. 6(2): p. 320-328.
2.Hogden, A., et al., Amyotrophic lateral sclerosis: improving care with a multidisciplinary approach. Journal of multidisciplinary healthcare, 2017. 10: p. 205-215.
3.Martin, S., et al., The benefit of evolving multidisciplinary care in ALS: a diagnostic cohort survival comparison. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2017. 18(7-8): p. 569-575.