Implementation of an integrated multidisciplinary Movement Disorders Clinic: applying a knowledge translation framework to improve multidisciplinary care

Abstract

Purpose

To evaluate the implementation of an integrated multidisciplinary Movement Disorder Clinic using a model of knowledge translation.

Methods

A mixed methods design was used to evaluate implementation outcomes. After recognising poor referral rates to allied health, Movement Disorder Clinic team-members identified implementation barriers. Team- and process-level implementation strategies were designed and tailored to address these barriers. The primary outcome measure was the change in the proportion of patients referred to allied health, determined by comparing pre- and post-implementation documentation audits. Secondary outcome measures included clinician and consumer surveys to identify ongoing implementation barriers and stakeholder satisfaction.

Results

Documentation from 90 medical records was included in the audits (post-intervention n = 45). There was a significant improvement in the referral rates to allied health from 53% to 84% (mean improvement 31%, p = 0.003, Fisher's exact test). However, documentation of disease education decreased by 38% (p = 0.000, Fisher's exact test). Movement Disorder Clinic team-members identified three main barriers to ongoing implementation: “memory and automaticity”, “environmental context and resources” and “beliefs about capabilities”. Thirty-seven consumer surveys were completed, showing high levels of satisfaction (86%) but ongoing educational needs (51%).

Conclusions

Implementation of an integrated multidisciplinary Movement Disorder Clinic was facilitated by a knowledge translation framework, leading to improved allied health referral rates and high levels of staff and consumer satisfaction, but unmet educational needs of consumers. Future research in the field of multidisciplinary healthcare for people with movement disorders is needed to determine the impact of these changes on patients’ healthcare outcomes.

Implications for rehabilitation

• Multidisciplinary integrated healthcare models may lead to better outcomes in progressive diseases such as Parkinson’s disease, however, can be challenging to implement.

• A knowledge translation framework facilitated successful implementation of an integrated multidisciplinary Movement Disorders Clinic, leading to significantly improved rates of appropriate referrals to allied health, and staff and consumer satisfaction.

• Team-members identified three main barriers to ongoing implementation – “memory and automaticity”, “environmental context and resources,” and “beliefs about capabilities” – which may impact sustainability and should be considered in future implementation efforts.

Keywords:

• Implementation
• multifaceted intervention
• evidence-based practice
• multidisciplinary team
• Parkinson’s disease
• movement disorders

Acknowledgements

Special thanks to Rhianna Friend for initiating this project, and Dr Tony Tampiyappa, Glennis McAlpine and the staff and consumers of the Movement Disorders Clinic at Maleny Soldiers Memorial Hospital for their participation.

Disclosure statement

The author was a clinician (speech pathologist) at Maleny Soldiers Memorial Hospital in 2017.