The role of primary care in management of rare diseases in Ireland

Background

‘Slaintecare’ aims to address complex patient care needs in an integrated fashion with an emphasis on patient-centred, patient-empowered community care.Currently there is a lack of knowledge of the impact of rare disease management in primary care and of the information tools required by general practitioners to deliver integrated care for rare disease patients.

Aims

To complete a pilot survey to estimate the general practice clinical workload attributable to selected rare diseases and assess the use of relevant information sources.

Methods

A retrospective cross-sectional survey was carried out of general practice consultations (2013–2017) for patients with 22 commonly recognised rare diseases.

Results

Around 31 general practitioners from 10 Irish practices completed information on 171 patients with rare diseases over 3707 consultations. General practice-specific coding systems were inadequate for rare disease patient identification. Over 139 (81.3%) patients were adult, and 32 (18.7%) were children. Management of care was hospital and not primary care based in 63%. Those eligible for state-reimbursed care had a significantly higher median number of consultations (23 consultations, IQR = 13–37, or 5.8 consultations/year) than those who paid privately (10 consultations, IQR = 4–19, or 2.5 consultations/year) (p < 0.005).General practitioners had access to public information resources on rare diseases but few had knowledge of (35.5%), or had ever used (12.9%) Orphanet, the international rare disease information portal.

Conclusions

Both specific rare disease-specific coding and use of the relevant rare disease information sources are lacking in general practice in Ireland.

How to organize multispecialty care for patients with Parkinson's disease

Neurodegenerative disorders like Parkinson's disease (PD) typically include a broad range of motor and non-motor symptoms. Disease manifestations vary considerably across individuals and, importantly, the individual needs and priorities are highly diverse among patients. It is widely felt that this multifaceted nature of PD calls for a team-oriented and personalized model of care. However, such a multispecialty approach is complex to design, and there are no evidence-based templates that describe how multispecialty care should be organized. Here we elaborate on the various challenges associated with the organization of team-based care. We illustrate this by highlighting new research evidence for two different models of multispecialty team care in PD. We also discuss several critical components of multispecialty care, including composition of the team, collaboration forms between team members, and implementation of multispecialty care within everyday healthcare settings. We close by sharing some of the lessons learned from recent clinical trials on the clinical effectiveness of multispecialty team interventions in PD. This review underscores that designing multispecialty care within the setting of a modern healthcare system is almost as complex as PD itself, and that its scientific evaluation comes with significant challenges.