Connecting Care Closer to Home: Evaluation of a Regional Motor Neurone Disease Multidisciplinary Clinic

Abstract

The optimal approach to managing motor neurone disease (MND) is through integrated, person-centred care (PCC), complemented by access to specialised MND multidisciplinary clinics (MDCs). However, in Australia, MND care is fragmented and uncoordinated.

Objectives: To evaluate participant experiences of the implementation of a new regional MND MDC in New South Wales, Australia, and explore factors influencing its implementation.

Methods: A qualitative evaluation was conducted. We used semi-structured interviews with people living with MND (plwMND) (n = 4), family carers (n = 2), healthcare providers (n = 6), and social care providers (n = 2). First, deductive analysis using the Theoretical Domains Framework and COM-B model was applied to identify factors influencing the adoption and sustainability of the MDC. Then, an inductive thematic analysis identified the impact of the MND MDC from participant perspectives.

Results: The MND MDC was found to be appropriate and acceptable for providing equitable access to PCC MND care that was 'closer to home'. The three main themes from the inductive analysis indicated that: 1. Implementing it was a 'good idea' [the MND-MDC]; 2. It 'flushes out' local service gaps and/or challenges; and 3. It results in positive outcomes. Key facilitators to implementation identified from the deductive analysis were staff expertise, strong trusting relationships with all clinic participants, and the belief that the MND MDC optimised care. Barriers to implementation included a lack of staff remuneration, organisational boundaries, limited representation of specialities, and anticipated difficulties in coordinating care with existing services.

Conclusions: The commitment to providing equitable access to an MND MDC in a regional area is crucial to optimise care for plwMND and their families. However, overcoming complex organisational boundaries, creating local solutions, and building strong partnerships are key challenges to securing ongoing financial support and local health district 'buy-in' to support sustainability.

Keywords: barriers; behaviour change; facilitators; implementation science; motor neurone disease; multidisciplinary clinic; regional health services.

Figure 1

Overview of the MND clinic’s operation pathway.

Figure 2

COM-B model of behaviour change. Arrows in the model represent the influence of one component on another. Note that opportunity and capability influence the relationship between motivation and behaviour, rather than the components individually. Figure adapted from Michie et al. (2011) [48].

Figure 3

Key barriers and facilitators in each domain of the Theoretical Domains Framework mapped to each component of the COM-B model of behaviour. (Barriers and facilitators run horizontally in rows, while TDF components are divided into columns).