Can Novel Approaches to Healthcare Delivery Improve Outcomes for People with Parkinsonism?

Abstract

The global prevalence of Parkinson’s disease is increasing, bringing with it a mounting burden. Current care is inadequate and underestimates the complexity involved in managing people with parkinsonism. There is no consensus on the optimal way to deliver care to people with parkinsonism to improve outcomes whilst being cost effective. To address current inadequacies in care, a novel multi-component model of care, PRIME-Parkinson, has been developed. Whether it can improve outcomes for people with parkinsonism and be cost-effective, is to be determined.

This thesis addresses these evidence gaps as follows: (i) I conducted a systematic scoping review to map the current research landscape of models of care for people with Parkinson’s disease. Comparing intervention rationale, aims and patterns of operational characteristics across studies using a standardised taxonomy, I have identified and described five domains of care model and identified common methodological limitations across this research landscape. (ii) I conducted a randomised controlled trial of the PRIME-Parkinson model of care in a population of people with parkinsonism (n=214) to determine its clinical and cost-effectiveness compared to usual care. The trial recruited to target and met its primary endpoint, demonstrating that the intervention was effective in improving personal goal attainment. The intervention arm also had better health-related quality of life, overall better disease control, improved problem-coping ability, patient-reported global impression of change and showed a trend towards reduced unplanned hospital admissions. (iii) I have also designed a mixed-methods process evaluation, which is embedded within the randomised controlled trial to explore how the novel and complex PRIME-Parkinson intervention was implemented, how and why it produced change, for who and under what conditions. The results of this will be presented following this thesis and will support the interpretation of the main trial results, guide ongoing refinement of the intervention and future implementation.

Date of Award	9 Dec 2025
Original language	English
Awarding Institution	University of Bristol
Supervisor	Emily J Henderson (Supervisor) & Yoav Ben-Shlomo (Supervisor)