Abstract
The prevalence of parkinsonism rises with age meaning many individuals are also living with frailty, multimorbidity and/or cognitive impairment. These health states contribute to clinical complexity, making health problems more challenging to manage and impacting on risk of adverse outcomes, including hospitalisation. However, patients with parkinsonism who are clinically complex are underrepresented in research.My thesis addresses three important areas: (i) I undertook a study using primary care data from Clinical Practice Research Datalink GOLD, with linkage to hospital admission data. The aim was to describe the reasons for, and risks and predictors of, emergency hospital admission amongst people with parkinsonism. (ii) I conducted a cross-sectional study to describe the needs, experience and
symptomatology of a more representative population of people with parkinsonism, including those lacking capacity to consent, using more intensive methods. (iii) I developed a framework for the “Proactive and Integrated Management and Empowerment” (PRIME) model of care, a multicomponent intervention aiming to address the complexity of parkinsonism, reviewed and selected a suitable primary outcome measure.
I found that age, parkinsonism duration, multimorbidity score, care home residence, urban residence and deprivation level predicted emergency admission. This allowed me to develop a model-predicted risk of emergency admission tool to support better prognostication and counselling. I demonstrated that participants recruited to the cross-sectional study better reflected “real-world” patients. More intensive engagement resulted in participants who were more likely to be female, frailer, living in a care home and with an atypical parkinsonism, compared to other participants. There was a high co-prevalence of frailty, polypharmacy and multimorbidity, contributing to clinical complexity. I believe that the PRIME model of care is more appropriately evaluated using a goal orientated outcome measure and adapted the Bangor Goal-Setting Interview technique which is currently being used as the primary outcome for the PRIME randomised controlled trial.
| Date of Award | 20 Jun 2023 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Yoav Ben-Shlomo (Supervisor) & Emily J Henderson (Supervisor) |