Service provision for patients with ALS/MND: A cost-effective multidisciplinary approach

Optimal management of patients with ALS/MND requires a team approach, with early referral to paramedical services for clinical assessment and prompt i ntervention. As the condition progresses, a flexible approach to management must be adopted by the medical team, with an ability to intervene at very short notice. We have developed an efficient multi-disciplinary clinic that services the ALS/MND population of Ireland by combining the existing infra structure of community services with a hospital-based specialist clinic. Th e clinic operates on a weekly basis, and is staffed by a core team includin g a neurologist, a liaison nurse, and the director of the ALS/MND Associati on. On-site and same-day physiotherapy, occupational therapy and speech the rapy is available, as is pulmonary evaluation. All patients utilising the c linical services are automatically included on the Irish Register of Motor Neurone Disease, and are tracked by the liaison nurse. The core members of the clinic interact regularly with paramedical staff within the community, ensuring that necessary community services are made available within 1-2 we eks of the clinic visit. Equipment necessary for the patient's well being i s made available free of charge by the Irish Motor Neurone Disease Associat ion, following an appropriate request from the regional para-medical staff. We have thus demonstrated that an effective multi- disciplinary care servi ce for ALS/MND can be developed at modest cost by close personal liaison be tween the existing health care structures and core members of a multidiscip linary team. (C) 1998 Elsevier Science B.V. All rights reserved.