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What is happening in Neurology?

What is happening in Neurology?. Orla Hardiman MD,FRCPI, FAAN Director of Neurology Beaumont Hospital. What is a Neurological Condition?. A condition that affects the brain, spine or muscle Can be roughly divided into 3 categories Physically disabling Non-Physically disabling

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What is happening in Neurology?

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  1. What is happening in Neurology? Orla Hardiman MD,FRCPI, FAAN Director of Neurology Beaumont Hospital

  2. What is a Neurological Condition? • A condition that affects the brain, spine or muscle • Can be roughly divided into 3 categories • Physically disabling • Non-Physically disabling • Loss of cognitive ability (Dementia)

  3. In Health Policy, Neurological Disorders can be Used as a Model for Management of Chronic Disease • Acute events with subsequent life long disability (stroke) • Treatable conditions that can be “normalised” (migraine, epilepsy) • Untreatable conditions that are fatal (motor neurone disease) • Untreatable conditions that are progressive and associated with high burden for patient and carer (Parkinsons, Alzheimers)

  4. Neurological Disability: The Brain Matters • 80% of 10 commonest disabling disease are neurological • In Europe, brain diseases cause a loss of 23% of years of healthy life • Brain diseases account for 50% of years lived with disability • 35% of the total burden of disability-adjusted life years caused by brain diseases

  5. Prevalence of Neurological Conditions in Ireland • Approx 500,000 (12%) suffer from a neurological disorder • Stroke is one of the leading causes of death and disability • Conditions are frequently undiagnosed : There is poor access to relevant specialists • No official data collection has been established for neurological conditions (except CJD) • No official management plan or strategy has been put in place

  6. Neurological Care in Ireland Equity of Care for People with Neurological Disability Studies from Beaumont Hospital

  7. Neurologists in Europe

  8. Community and Outpatient Services

  9. Out patient Clinics 9 weekly Neurology clinics at Beaumont 3 general 6 specialist Approximately 50 new patients and 90 return patients seen each week However….

  10. Summary of Current Status • 28% of patients with progressive neurological disability (Multiple Sclerosis or Motor Neurone Disease) have never or rarely seen a neurologist… • Larger percentage of patients with other neurological conditions are not followed by a neurologist • The waiting list for a new patient in a Neurology clinic is 2 years • Private clinics have longer waiting lists than public clinics

  11. Community Services • The waiting list for community occupational therapy is a minimum of 9 months except in extreme cases • Community based Speech and Language Therapy non-existent for adults • Services are “means tested”: Require medical card for access • Services not available in the private sector

  12. Access to Community Physiotherapy and Occupational Therapy by patients with Multiple Sclerosis and Motor Neurone Disease

  13. In Patient Services Beaumont Hospital In-Patient Audit

  14. Admissions to Beaumont Neurology corrected for Regional Population

  15. In Patient Admissions to Neurology at Beaumont Hospital 2003 (n=650)

  16. Waiting Lists for Admission Geographic Inequity

  17. Patients on waiting list compared with admissions

  18. WAITING TIMES FOR PATIENTS WHO WERE ADMITTED

  19. Top five “elective” admissions

  20. Patients Waiting for Admission for longer than 6 Months

  21. Multidisciplinary Clinics Beneficial Effects of Multidisciplinary Management

  22. Hospital based Neurologist Specialist nurse Physiotherapist Occupational therapist Speech & language Nutritionist Psychologist Social worker Palliative care team Community based Specialist nurse Voluntary organisation Public health nurse Occupational therapist Physiotherapist Speech and Language Social Services Palliative care home team Multidisciplinary Teams

  23. Effect of a Multidisciplinary Clinic on Survival in Motor Neurone Disease Logrank p = 0.003

  24. Multidisciplinary Clinics: Evidence from other Countries • Better survival • Fewer emergency admissions • Shorter length of stay when hospitalised • Better management of symptoms • Improved quality of life • Lower rates of carer burnout

  25. Why has there been no Investment in Neurology? Reactive versus Proactive Health Policy

  26. Waiting Lists Excessive reliance on unverified / inaccurate data, including waiting list data • Minimal audit of waiting list management: • Equity not assessed or validated • Assumption that “outcome” is associated with “procedure” (usually surgical)

  27. What Needs to be Done • We need to develop more sophisticated measurement tools that can capture complex conditions • We need to develop methods to capture out-patient services and activities • We need to audit and monitor our activity to ensure that we are capturing real need

  28. What Needs to be Done (cont’d) • We need to be sensitive to hidden inequities within the health services • We need measurement tools that assess continuity of care

  29. What Needs to Be Done? • We need to invest in the delivery of Neurological Services

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