Development of an evidence-based reference framework for care coordination with a focus on the micro level of integrated care: A mixed method design study combining scoping review of reviews and nominal group technique.

BACKGROUND: Because of the limits in conceptualisation of care coordination linked to a large array of care coordination models and definitions available, a care coordination framework is needed with a particular focus on the micro level. OBJECTIVE: To develop an evidence-based reference framework for person-centred care coordination interventions based on international validated definitions. METHODS: This two-step mixed-methods study included first, a scoping review of reviews focus on the impact of care coordination interventions and then, a nominal group technique. The scoping review aimed at identifying the components of the four dimensions of the framework (contexts, activities, actors and tools, and effects). The nominal group technique was to select the relevant components of the dimension 'activities' of the reference framework. RESULTS: The scoping review selected 52 articles from the 1407 retrieved at first. The nominal group selected the 66 most relevant activities from the 159 retrieved in the literature (28 activities of care organisation, 24 activities of care, and 14 activities of facilitation). CONCLUSION: This operational framework focused on care coordination at the micro level, is a useful and innovative tool, applicable in any clinical condition, and in any health care system for describing, implementing and evaluating care coordination programmes.

Tratamiento de las complicaciones motoras en la enfermedad de Parkinson / Treatment of motor complications in Parkinson's disease

RESUMEN Las fluctuaciones motoras y las discinesias hacen parte de las complicaciones motoras que invariablemente se presentarán con la progresión y avance de la enfermedad de Parkinson. Se estima que el 90 % de los pacientes las padecen después de 10 años de enfermedad. El tratamiento de estas condiciones requiere entender el patrón, las características y el tipo de fluctuaciones o discinesias de cada paciente. En este capítulo se realiza una revisión detallada sobre cada una de estas complicaciones motoras y se muestran los algoritmos para su abordaje y manejo, incluyendo las indicaciones y recomendaciones de las terapias avanzadas disponibles en Colombia, como la cirugía de estimulación cerebral profunda y la apomorfina subcutánea.

SUMMARY Motor fluctuations and dyskinesias are complications that invariably occur with the progression of Parkinson's disease, affecting about 90 % of patients after ten years of disease. The treatment of these conditions requires an understanding of the pattern, features and type of motor fluctuations and dyskinesias in each patient. In this chapter, the characteristics of motor complications are reviewed and the strategies and algorithms for its management are described, including the indications and recommendations of the available advanced therapies in Colombia, such as functional neurosurgery and subcutaneous apomorphine.

Consenso de la Asociación Colombiana de Neurología sobre el uso de apomorfina en la enfermedad de Parkinson / Colombian Association of Neurology Consensus on the use of Apomorphine in Parkinson's disease

La apomorfina es un agonista dopa que se viene usando desde hace más 25 años en el tratamiento de la enfermedad de Parkinson avanzada con complicaciones motoras complejas, por lo cual sigue siendo de gran importancia en el tratamiento de esta etapa de la enfermedad. En el siguiente escrito, realizado por el Comité de Movimientos Anormales de la Asociación Colombiana de Neurología, se hace una revisión respecto a la medicación, su eficacia y el papel en el manejo de la enfermedad de Parkinson, así como una comparación entre las diferentes terapias avanzadas disponibles hoy en día. De la misma manera el Comité hace recomendaciones sobre las indicaciones, elección de candidatos y protocolos para el inicio de las diferentes formas de administración (intermitente e infusión continua) para optimizar el uso de esta terapia y facilitar la adherencia al tratamiento. Por otra parte, se revisan los efectos adversos relacionados con la terapia y se hacen recomendaciones sobre el manejo de las mismas, el seguimiento que se debe hacer a los pacientes que reciban apomorfina y las claves en el tratamiento a largo plazo. long term.

Apomorphine is a dopamine agonist that has been used for more than 25 years in the treatment of advanced Parkinson's disease with complex motor complications, becoming an important treatment option for this stage of the disease. In the following document, written by the movement disorders committee of the Colombian Association of Neurology, an extensive review is made about this medication, its efficacy and role in the management of Parkinson's disease as well as a comparison between the different advanced therapies available today. Additionally, recommendations about the indications, election of candidates and protocols for choosing between the different forms of administration (intermittent and continuous infusion) are establish according current evidence in order to help clinicians to optimize the use of this therapy and facilitate adherence to treatment. On the other hand, adverse effects related to the therapy are reviewed and recommendations are made about their management, as well as a protocol to follow-up patients receiving apomorphine and keys in the long term.