Parkinson’s: the centres and expertise are there, but Italy still needs to ‘network’
Care pathways must be established, along with seamless links to facilities providing highly complex treatments: an overview from the Limpe-Dismov Society
When it comes to the treatment of Parkinson’s disease, Italia still lacks structured care networks guaranteed by the National Health Service. The country can rely on clinical expertise spread throughout the country, although highly complex treatments are carried out in only a limited number of centres. This is the finding of the first national survey of Centres for Advanced Parkinson’s Therapies, carried out by the Italian Society for Parkinson’s and Movement Disorders (Limpe-Dismov), in which 75 centres across 17 regions took part.
A profile of the disease
Parkinson’s disease is a chronic neurodegenerative condition that requires comprehensive care throughout its course. At the onset, management is relatively straightforward, but it becomes more complex as the disease progresses, when advanced therapies may be required. These include continuous drug infusions (subcutaneously or directly into the intestine), deep brain stimulation (DBS) via electrodes implanted in the brain, and focused ultrasound (MRgFUS), which is performed without incisions under MRI guidance. However, technology alone is not enough: patient screening, a multidisciplinary approach, skilful execution of the procedure and continuous follow-up are all essential.
The state of the art
The map shows that centres for advanced Parkinson’s treatments are widely distributed across the country, with 32 in the North, 21 in the Centre, and 22 in the South and on the islands. The regions with the highest number of centres are Lombardy (11), Lazio (10) and Sicily (7).
In terms of expertise, the picture is robust. Patient management and the selection of candidates for the most complex therapies are available across almost the entire country. Infusion therapies, which are the most established, are available in all 17 regions covered by the survey, across a total of 74 centres. For deep brain stimulation (DBS), 62 centres identify candidates eligible for treatment, but the implant can be performed in 28 of these, located in 16 out of 17 regions (the sole exception being Puglia). However, the provision of post-operative follow-up care is widespread: 52 out of 75 centres provide this service. Treatment with focused ultrasound (MRgFUS), on the other hand, is much more limited: 47 centres select eligible candidates, but only 5 actually perform the procedure: in L’Aquila, Messina, Milan, Naples and Verona.
We need public PDTA centres
“The figures paint a picture of a system with expertise widely distributed across the country,” says Professor Alessandro Tessitore, president of the Limpe-Dismov Society. The key issue is organisational: the solution is not to replicate every technology in every facility, but to establish dedicated care pathways for Parkinson’s disease, recognised and funded by the National Health Service, capable of linking local centres to specialist centres and moving beyond the models currently reliant on the initiative of individual professionals. Only in this way will access to appropriate care cease to depend on where one lives.”
A key factor in access to advanced therapies is the referral of patients: when an advanced therapy is not available on-site, the Centre must refer the candidate elsewhere, and this process is not always clearly defined. Of the 63 centres that responded to this question, 38 reported having a formal partnership with the facility providing the therapy, whilst the remaining 25 refer patients without a formal agreement or without specifying a particular centre.
