'I'm not sure who to refer you to': experiences of clinicians accessing allied health for their patients with Parkinson's disease

Rationale: Allied health interventions have been shown to improve impairments and quality of life in people with Parkinson's disease (PwPD). However, globally allied health is underutilised, and referrals tend to be reactive and occur in moderate to advanced disease. Currently little is known about the referral patterns of PwPD to allied health in Australia.

Aims: This study examined the allied health referral patterns of neurologists, general practice physicians (GP) and Parkinson's disease nurse specialists (PDNS) treating PwPD in New South Wales (NSW), Australia.

Methods: Four neurologists, three GPs and four PDNSs each completed a demographic questionnaire and a semi-structured interview. Interview data were analysed using inductive thematic analysis.

Results: All clinicians experienced difficulties locating approachable, available, affordable, and appropriate allied health services. Clinicians also perceived that patient ability to interact impacted their involvement in allied health therapies. Referrals were typically made in response to symptom progression. The most common individual disciplines referred to were physiotherapy and/or exercise physiology, followed by speech pathology and occupational therapy. Multidisciplinary teams (MDT) were generally not available, so referrals to MDTs occurred less frequently.

Conclusion: Clearer guidelines regarding when to refer to individual allied health disciplines and to MDTs are needed to facilitate more proactive referrals by clinicians treating PwPD. Establishing an MDT model for PwPD throughout Australia would improve the approachability, availability and appropriateness barriers, and could improve quality of life for PwPD.