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Fortschr Neurol Psychiatr 2020; 88(06): 362-373
DOI: 10.1055/a-1083-6316
Originalarbeit

Die Hamburger Parkinson-Tagesklinik: Ein neues Behandlungskonzept an der Grenze zwischen stationärer und ambulanter Versorgung

The Hamburg Parkinson day-clinic: a new treatment concept at the border of in- and outpatient care
Odette Fründt
1   Neurologie, Universitatsklinikum Hamburg-Eppendorf
,
Ermir Veliqi
1   Neurologie, Universitatsklinikum Hamburg-Eppendorf
,
Beate Schönwald
1   Neurologie, Universitatsklinikum Hamburg-Eppendorf
,
Polina Sychla
2   Kaufmännische Abteilung, Universitatsklinikum Hamburg-Eppendorf
,
Christian Gerloff
1   Neurologie, Universitatsklinikum Hamburg-Eppendorf
,
Carsten Buhmann
1   Neurologie, Universitatsklinikum Hamburg-Eppendorf
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Zusammenfassung

Hintergrund Für Patienten mit komplexem Parkinson-Syndrom (PS), die einer durchgreifenden Umstellung von Medikation, Pumpeneinstellung oder Tiefer Hirnstimulation bedürfen, ist die ambulante Behandlung oft aufgrund limitierter zeitlicher und / oder fachlicher Ressourcen nicht ausreichend, die stationäre Versorgung bei fehlender Alltagsbelastung im Klinikalltag jedoch ebenfalls nicht adäquat. Das Modell der Hamburger Parkinson-Tagesklinik (PTK) wurde entwickelt und etabliert, um diese Versorgungslücke zu schließen.

Methode Hier beschreiben wir das neue und umfassende, individuelle und interdisziplinäre Behandlungskonzept der PTK. Die Veränderungen von motorischen und nichtmotorischen Symptomen nach drei Wochen und fünf Behandlungstagen in der PTK werden anhand objektiver Skalen präsentiert, und die subjektive Bewertung der Behandlung verschiedener Einzelaspekte (Konzept, Therapeuten, individueller Nutzen etc.) wird durch die Patienten dargestellt.

Ergebnisse Von den 334 Patienten mit PS (im Alter von 36 bis 87 Jahren mit Hoehn- und Yahr-Werten zwischen 1,0 und 4,5), die innerhalb eines Zeitraums von 32 Monaten in der PTK behandelt und evaluiert wurden, erhielten 309 Patienten die Diagnose eines idiopathischen Parkinson-Syndroms (IPS). Die Behandlung in der PTK führte zu einer Verbesserung der Motorik (MDS-UPDRS III; p < 0,05) und aller untersuchten nichtmotorischen Scores (BDI-II, MoCA, PDNMS, PDSS-2, KPPS, QUIP, PDQ-39; p < 0,05) und erzielte somit eine Verbesserung von Akinesie, Tremor, Dyskinesie, Kognition, Schlaf, Schmerzen, Impulskontrollstörungen und Lebensqualität. Auf einer 6-Punkte-Likert-Skala mit Schulnoten von 1 („sehr gut“) bis 6 („ungenügend“) bewerteten die Patienten ihre Behandlung in der PTK als positiv mit Noten von 1,3 bis 2,4 („sehr gut“ bis „gut“) je Kategorie sowie mit einer Gesamtnote von 1,5 („gut“).

Schlussfolgerungen Patienten mit fortgeschrittenem und / oder komplexem Parkinson-Syndrom profitieren vom Konzept der PTK, das eine Lücke zwischen stationärer und ambulanter Versorgung schließt.

Abstract

Objective To close a gap between inpatient and outpatient care, the Hamburg Parkinson day clinic (HPDC) was developed offering new comprehensive, individual, interdisciplinary type of treatment for patients with complex Parkinsonian syndromes (PS).

Methods First, we describe the HPDC concept, in which a multi-professional medical team of PD specialists provides a time- and personnel-wise intensive care and focuses on the patients’ individual deficits and resources. Second, we present short-term outcome results of 334 PS patients enrolled during a period of 32 months including objective clinical motor and non-motor scores taken before and after participation in the HPDC as well as the patients’ subjective evaluation of the HPDC. Results: Out of the 334 patients with PS (aged 36-87 years with Hoehn and Yahr scores between 1.0 and 4.5), 309 were diagnosed to have Parkinson’s disease (PD). HPDC treatment led to improvement in motor function (MDS-UPDRS III) and all investigated non-motor scores (BDI-II, MoCA, PDNMS, PDSS-2, King’s PD Pain Scale, QUIP, PDQ-39; p<0.05), indicating benefits regarding akinesia, tremor, dyskinesia, cognition, sleep, pain, impulse control disorders and quality of life. Patients assessed HPDC care positively with values from 1.3 to 2.4 (‘very good’ to ‘satisfying’) with an overall grade of 1.5 (‘good’) on a 6-point Likert scale (1-6: best to worst).

Conclusions Patients with advanced PS benefit from the HPDC concept which is considered to close a gap between inpatient and outpatient care.

Schlüsselwörter

Parkinson - stationär - ambulant - Tagesklinik - Behandlung - Versorgung

Key words

Parkinson’s Disease - in-patient - out-patient - day-clinic - treatment - care


Publication History

Received: 15 September 2019

Accepted: 12 December 2019

Article published online:
17 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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