JOURNAL CRITICISM

T he Rationale For Improved Integration Between Home Care And Neurology Hospital Services In Patients With Advanced Parkinsons Disease

By: Group 1 B Shindy Anggreini Putri Yolanda Annisa Aji Yossie Charolina 105070201131001 105070201131011 105070201131015

K3LN 2010 NURSING DEPARTEMENT MEDICAL FACULTY BRAWIJAYA UNIVERCITY 2011

T he Rationale For Improved Integration Between Home Care And Neurology Hospital Services In Patients With Advanced Parkinsons Disease
Authors : Angelo Antonini Luisa Mir Carlo Castiglioni Gianni Pezzoli

I.Analysis Of The Article

At least one third of outpatient visits, as well as over 50% of emergency ward (EW) visits and admissions for PD (DRG 012) involve patients in an advanced stage of the disease. For example, at a county hospital in Vimercate, there were 373 EW visits for DRG 12 (Parkinson disease) in the period from 2000 to 2005; 72% were admitted to General Medicine or Surgery and only 28% to the Neurology ward. Once patients are admitted, the average number of hospitalisation days is still very high in Italy and reflects difficulties in the management of complications in these patients, particularly when neurologists are only marginally involved (see Table 1). Symptom control in PD patients often requires the use of high-cost alternative therapies which are characterised by particular drug administration methods or by direct intervention through neurostimulation of cerebral areas such as the subthalamic nucleus: 1. Apomorphine. This drug is administered subcutaneously through an infusion micro-pump that normally used in day-time hours only and must be reutilized. Patients must be trained in the use of the pump, which is programmed by the reference clinical centre and periodically refilled by patients. The quantity of materials must be adequate to the needs (most side effects affecting the skin are due to reutilisation of already used materials and poor hygiene at the infusion site). 2. Duodopa. This drug is administered into the jejunum through an ostomy using an external infusion device (pump), therefore patients must undergo a minor surgery procedure in order to then receive therapy. 3. Neurostimulation : Deep Brain Stimulation (DBS). Neurostimulation is carried out by applying a pacemaker whose electrode is positioned in the subthalamic region or the internal globus pallidus bilaterally. Electrostimulation is normally started 16 weeks after implantation. Currently patients are usually instructed by their reference clinical centre on how they should behave to manage their therapies, but

training only takes place in hospital facilities; when patients go back home, no support is provided, and the only point of reference for these patients is their clinical centre, which they access either by phone or directly, showing up at outpatients departments. To help develop this phase, the authors proposing an approaching step for patients who can no longer adequately control their disease by oral therapies.

Management for each therapy and standard care :

Given the current environment, it is critical to define a structured pathway for patients with advanced PD that will ensure their management in the community and reduce hospital visits. Active management, possibly through a dedicated call centre, will help identify clinical issues that must be supported by the reference centre and separate them from those that can be managed either directly by the patient or by a home care service. In conclusion, these interventions will help to maintain residual autonomy as long as possible, eventually leading to reduced emergency ward visits and unnecessary hospitalisations.

I.Suggestion Over The Article

Advantages of the journal 1. It explained that actually neurology ward is important for Parkinsons Disease patients rather than general medicine or surgery. The fact shows in Vimercate, Italia, only 28% were admitted to the neurology ward while the rest are cared for in general Medicine and surgery. After the patients were treated in general medicine or surgery, the average number of days of hospitalization is still very high, and reflects the difficulty in the management of complications. 2. In the journal also explained if the management of Parkinson's disease requires a good medicine. When the patient can go home to their house (outpatient care), patient's family should also be given more education so that the medicine management remain good for at home and not go back to be hospitalized. 3. As nurses, we actually have a great opportunity related to home care, it might be services or the like. Because the research which took place in Italy, precisely in district Vimercate, Parkinson's patients hospitalization were much longer in general medicine and surgical treatments with the reasons because the less focus and difficulty in managing its complications. Disadvantages journals:
1. Samples of this journal is limited, only one area. Shall in more

than one area in order to strengthen this study. 2. No more in-depth explanation of Parkinson's disease itself, whereas in the journal mentioned abstrack Parkinson's disease. The journal described only related to the management of Parkinson's alone, the authors should provide more explanation related to Parkinson's disease. 3. Explanation of activities related to home care and hospital activities only described with scheme. It should also describe the written essay in order make it easier for readers to understand

clearly about the differences in hospitalization and caring home .

I.Application Of The Research In Health Care Setting In Indonesia

Integrated Home Care which was researched by the authors substantively can be done in Indonesia especially by nurse to increase successfulness of treatment after patients were discharged from hospital. The problem is, home care management in Indonesia doesnt work well and often blocked by the always-changing policy of Health Department. In Indonesia, Parkisons diseases treatment and ways to improve the control of body movements and perform basic functions are founded, such as walking and dressing. Also there are therapy such as music therapy. If this treatment are applied in home care like what were implemented in journal, it will give a huge advantages for patients and their family. Health professional in Indonesia also give explanations about the whole disease to patients and their familiy, this will make an understanding for better cooperation if the Integrated Home Care are carried out.