Implementation evaluation of a motor neurone disease multidisciplinary clinic informing solutions to improve connected care

Introduction:
Motor neurone disease (MND) is a complex neurodegenerative condition with no cure. The optimal evidence-based approach to the management of MND is integrated, person-centred care (PCC), and access to specialised MND multidisciplinary clinics (MDC).

Background:
Adopting these approaches to care improves quality of life, health outcomes, care experiences and decision-making for people living with MND (plwMND) and their families. However, changes to the way services are accessed and offered in Australia, with the implementation of age-based funding models (My Aged Care and National Disability Insurance Scheme (NDIS)), has impacted collaborative interdisciplinary working practices, and connected and coordinated cross sector care for plwMND. The implementation evaluation of a MND MDC on the Central Coast, New South Wales, Australia, explored the implementation barriers and enablers to inform co-designed interventions that support equitable, coordinated, and connected PCC across health, disability, and aged care sectors.

Methods:
A mixed methods implementation evaluation informed by qualitative methods used semi-structured interviews with plwMND(4), family caregivers(2), health(6) and social care(2) providers attending the clinic. The key stakeholder advisory group provided guidance and feedback on various components of the evaluation. A hybrid deductive/inductive analysis approach to coding of data underpinned by the Theoretical Domains Framework (TDF) was adopted, to ensure non-TDF-related factors were not overlooked, and nuance and context were not lost. Successful implementation strategies, and barriers and enablers influencing adoption, delivery, and sustainability of MND MDC, were systematically identified through the TDF.

Results:
The acceptability and appropriateness of providing equitable access to a specialist multidisciplinary team (MDT) that is ‘closer to home’ and adopts a person-centred approach to connect and support plwMND and their families within their local context, was demonstrated. Key enablers influencing the MND MDC implementation, relevant to the 14 domains of the TDF, are the MDT clinical expertise in MND management (skills), the ability of MDT to work interprofessionaly and transdisciplinary (skills, social/ professional role & identity), trusting relationships (social influence), access to administration team, centrally located clinic space and technology (environmental context and resources), and the strong belief that the MND MDC optimises care and treatment (belief about consequences). Barriers related to lack of funding for MDT members clinic time, cross sector challenges and organisational boundaries impacting collaboration (environmental context & resources); limited representation of palliative and respiratory specialist teams and absence of gastroenterology team (skills); and communication hurdles impacting information sharing and networking (belief about consequences). Unexpected positive outcomes of MND MDC included ongoing goodwill of MDT, valuable contribution to filling service gaps, and creating stronger connections between plwMND and families, and health and social care providers.

Conclusion:
The commitment to providing equitable access to a MND MDC in a regional area to optimise health outcomes and care experiences for plwMND and their families, is crucial. Our findings are providing the catalyst to breaking down complex organisational boundaries, informing local solutions to improve collaborative practices and building stronger partnerships, critical to developing the MND MDC and coordinating care. Securing financial support and local health district ‘buy in’ is necessary to ensure sustainability.

Short description:
This paper presents the barriers and enablers to the implementation of a motor neurone disease multidisciplinary clinic in a regional area of New South Wales and demonstrates how this information can help inform co-designed interventions that support equitable, coordinated, and connected PCC across health, disability, and aged care sectors.