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Review
. 2017 Jan 4:10:13-27.
doi: 10.2147/JMDH.S111369. eCollection 2017.

The role and structure of the multidisciplinary team in the management of advanced Parkinson's disease with a focus on the use of levodopa-carbidopa intestinal gel

Stephen W Pedersen  1 , Martin Suedmeyer  2 , Louis W C Liu  3 , Dirk Domagk  4 , Alison Forbes  5 , Lars Bergmann  6 , Koray Onuk  6 , Ashley Yegin  6 , Teus van Laar  7
Affiliations
Review

The role and structure of the multidisciplinary team in the management of advanced Parkinson's disease with a focus on the use of levodopa-carbidopa intestinal gel

Stephen W Pedersen et al. J Multidiscip Healthc. .

Abstract

A multidisciplinary team (MDT) approach is increasingly recommended in Parkinson's disease (PD) treatment guidelines, but no standard of care exists for such an approach, and the guidelines do not provide clarification on how it should be implemented. This paper reviews evidence of MDT interventions in people with PD and provides expert clinical perspectives for an MDT approach, with a focus on advanced PD and levodopa-carbidopa intestinal gel (carbidopa-levodopa enteral suspension in the USA). The key recommendations are to enable the best possible treatment of people with PD locally by facilitating a close structured collaboration of different health care professionals working in a fixed network structure; to refer people with PD to established MDT centers in a timely manner; to establish regular meetings for the MDT enabling interdisciplinary exchange and learning; to optimize individual treatment and carefully evaluate available treatment options; to ensure treatment decisions are agreed jointly between people with PD, their caregivers, family, and health care professional; and to include specialists outside of neurology from adjuvant medical departments as necessary when implementing advanced therapies.

Keywords: Parkinson’s disease; advanced therapy; carbidopa-levodopa enteral suspension; levodopa-carbidopa intestinal gel; multidisciplinary team.

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Conflict of interest statement

Pederson SW is a member of advisory boards for Ipsen, Allergan, Almira, Abbott, AbbVie, Sativex and has no share porfolio in medical companies. PSW also received lecture grants from Ipsen, AbbVie. van Laar T has received speaker fees from Britannia Pharmaceuticals, AbbVie, and Medtronic and also a research grant from AbbVie. Suedmeyer M has received grants and/or honoraria for consultancy from Teva, Medtronic, St Jude Medical, Novartis, Meda, and Abbvie. Liu LWC acts as a speaker and is on the advisory board of Abbvie, Allergan Canada, Takeda, and Actavis. Domagk D has received honoraria for lectures from Olympus and consultancy fees from Hitachi Medical Systems and AbbVie. Forbes A is an independent consultant PDNS to AbbVie. Onuk K, Bergmann L, and Yegin A are employees of AbbVie, holding stock/stock options. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Examples of multidisciplinary team networks aiming to provide comprehensive and collaborative care for people with PD. Notes: (A) Network interaction within the PD multidisciplinary team in Denmark supporting information exchange about patients. (B) The Rigshospitalet Glostrup model. Abbreviations: PD, Parkinson’s disease; DBS, deep brain stimulation; GP, general practitioner; MDS, movement disorder specialist; PDNS, Parkinson’s disease nurse specialist.
Figure 2
Figure 2
The one-page, wall-mounted illustrated titration protocol clarifying the role and responsibilities of nurses throughout the titration process at the Hospital General Universitario Gregorio Marañón, Madrid, Spain. Notes: This poster is one component of the hospital’s “clinical pathway” that coordinates the protocols for each role in the MDT. Steps of this protocol reflect regional use and not necessarily label instructions for this product. Courtesy from Drs Carmen Funes Molina and Francisco Grandas, (translated from Spanish). Abbreviations: IV, intravenous; PEG, percutaneous endoscopic gastrostomy; ECG, electrocardiography; LCIG, levodopa-carbidopa intestinal gel.
See this image and copyright information in PMC

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