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Assessment of health needs in multidisciplinary care
  1. C A Young
  1. Walton Centre for Neurology & Neurosurgery, Lower Lane, Fazakerley, Liverpool L9 7LJ
  1. Correspondence to:
 C A Young;
 carolyn.young{at}thewaltoncentre.nhs.uk

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Comprehensive care for people with disabling neurological disease—finding the best approach

Comprehensive care for people with disabling neurological illnesses is widely acknowledged to require input from many specialisms. The foundation of such multifaceted care should be a detailed assessment of physical and psychosocial function and health needs, ideally by experienced individuals able to work in a transdisciplinary way and possessing excellent communication skills. Such individuals would be capable of both identifying a clinical problem, such as impaired heel strike, and determining the most appropriate treatment, such as stretches from the physiotherapist, botulinum toxin from the physician or orthopaedic release. Clearly clinicians with the wide training and experience for such global assessment are in short supply. In their absence, other approaches to identifying health needs for multidisciplinary care have been assessed. Asking each discipline to independently assess the patient in case his or her input could be relevant is a poor use of resources and burdensome to the patient. Being seen simultaneously by a wide range of rehabilitation professionals was the least popular format for a multidisciplinary neurological clinic.1 So if individualised assessment is not available to all, and the unfocused approach is unpopular and wasteful, can an instrument be used to guide assessment? In the paper by Hoogervorst et al (this issue, 20–24) the utility of the INTERMED in identifying multidisciplinary care needs in people with multiple sclerosis was assessed. This instrument involves a single professional observer conducting a structured interview across biological, psychological, social, and health care domains.

Validation of assessment instruments that encompass the spectrum of health needs is an important area for future research. The possibility of a clinician using a single instrument to assess several health domains offers clear advantages with regard to time, intrusiveness to the patient, and integration of a care plan. However, it will be important to research the relationship between the health needs indicated by such assessments and the patients’ perception of their health needs. There is often poor concordance between health needs identified by disabled people compared with professionals involved in their care.3

There are several interesting methodological approaches to be explored in striving to increase the accuracy and completeness of instruments aiming to assess patients’ function and health needs. Firstly, the use of patient self-report measures would be efficient and address some concerns over the mismatch of perceptions between professional and patient. For example, it may be that patient self-report could be used to assess disability in multiple sclerosis.4 Secondly, the sophistication of audio-assisted self-interviewing may allow information to be obtained without a clinician needing to administer the assessment. Indeed, randomised controlled trials suggest potentially sensitive questions may be answered more honestly by computer-assisted interviewing.5

Improving assessment of health needs is futile if needs are not to be met. Underpinning research to improve assessment therefore must be a commitment to provide services. Those organising, and funding, multiple sclerosis care might reflect on the health needs identified in the 100 consecutive new patients with multiple sclerosis referred to neurology outpatients who underwent a detailed assessment (for the INTERMED study), whether or not they appeared to need multidisciplinary care. For 61%, another discipline besides the neurologist and multiple sclerosis nurses was needed.

Comprehensive care for people with disabling neurological disease—finding the best approach

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