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Integrated Care and Network Formation for the Treatment of Parkinson’s Disease and Other Movement Disorders

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (31 July 2020) | Viewed by 46460

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Special Issue Editors

Prof. Dr. Lars Tönges

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Guest Editor

Department of Neurology, Ruhr-Universität Bochum, Bochum, Germany
Interests: Parkinson’s disease; neuron; neuroprotection; neuroregeneration; neuroinflammation; neurodegeneration; biomarkers; protein aggregation; alpha-synuclein; translational therapies
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Carsten Eggers

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Guest Editor

Department of Neurology, University of Cologne, Cologne, Germany
Interests: Parkinson’s disease; network formation; multidisciplinary care

Special Issue Information

Dear Colleagues,

The efficient provision of specialized and individualized interdisciplinary care for patients with Parkinson´s disease and other movement disorders needs a close interaction of care providers such as primary care physicians, neurologists, movement disorder specialists, therapists, nursing services, social workers, and others. Depending on the local setting, the optimized organization of such networks can vary considerably but should comprise key components such as effective communication structures, specially trained personnel, respect to evidence-based treatment guidelines, patient-centered approaches, and transparent evaluation of outcome results. The establishment and development of the rapidly growing field of integrated care and network formation needs a scientific analysis that also includes aspects such as socioeconomic evaluation, implementation in existing healthcare structures, development of guidelines for care provision, and new methods of interactive communication, including telehealth tools. We invite researchers from different fields, including clinical neurology, hospital and ambulatory care medicine, epidemiology, neurosciences, therapist and nursing science, to submit their original work or reviews to this Special Issue

Prof. Dr. Lars Tönges
Prof. Dr. Carsten Eggers
Guest Editors

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Keywords

Parkinson’s disease
Movement disorders
Epidemiology
Integrated care network
implementation
Integrated care network development
Interdisciplinary treatment
Marketing for care networks
Communication in care networks
Telehealth
Care provision guidelines

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Published Papers (12 papers)

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Research

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25 pages, 2890 KiB

Open AccessArticle

Parkinson Network Eastern Saxony (PANOS): Reaching Consensus for a Regional Intersectoral Integrated Care Concept for Patients with Parkinson’s Disease in the Region of Eastern Saxony, Germany

by Kai F. Loewenbrück, Doron B. Stein, Volker E. Amelung, Robert Bitterlich, Martin Brumme, Björn Falkenburger, Annekathrin Fehre, Tim Feige, Anika Frank, Carola Gißke, Claudia Helmert, Linda Kerkemeyer, Andreas Knapp, Caroline Lang, Annegret Leuner, Carina Lummer, Mirella M. N. Minkman, Gabriele Müller, Marlena van Munster, Hannes Schlieter, Peter Themann, Nick Zonneveld and Martin Wolz Show full author list Hide full author list

J. Clin. Med. 2020, 9(9), 2906; https://doi.org/10.3390/jcm9092906 - 8 Sep 2020

Cited by 10 | Viewed by 4104

Abstract

As integrated care is recognized as crucial to meet the challenges of chronic conditions such as Parkinson’s disease (PD), integrated care networks have emerged internationally and throughout Germany. One of these networks is the Parkinson Network Eastern Saxony (PANOS). PANOS aims to deliver timely and equal care to PD patients with a collaborative intersectoral structured care pathway. Additional components encompass personalized case management, an electronic health record, and communicative and educative measures. To reach an intersectoral consensus of the future collaboration in PANOS, a structured consensus process was conducted in three sequential workshops. Community-based physicians, PD specialists, therapists, scientists and representatives of regulatory authorities and statutory health insurances were asked to rate core pathway-elements and supporting technological, personal and communicative measures. For the majority of core elements/planned measures, a consensus was reached, defined as an agreement by >75% of participants. Additionally, six representatives from all partners involved in the network-design independently assessed PANOS based on the Development Model for Integrated Care (DMIC), a validated model addressing the comprehensiveness and maturity of integrated care concepts. The results show that PANOS is currently in an early maturation state but has the potential to comprehensively represent the DMIC if all planned activities are implemented successfully. Despite the favorable high level of consensus regarding the PANOS concept and despite its potential to become a balanced integrated care concept according to the DMIC, its full implementation remains a considerable challenge. Full article

(This article belongs to the Special Issue Integrated Care and Network Formation for the Treatment of Parkinson’s Disease and Other Movement Disorders)

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34 pages, 2163 KiB

Open AccessArticle

Structured Care and Self-Management Education for Persons with Parkinson’s Disease: Why the First Does Not Go without the Second—Systematic Review, Experiences and Implementation Concepts from Sweden and Germany

by Jenny Tennigkeit, Tim Feige, Maria Haak, Carina Hellqvist, Ümran S. Seven, Elke Kalbe, Jaqueline Schwarz, Tobias Warnecke, Lars Tönges, Carsten Eggers and Kai F. Loewenbrück

J. Clin. Med. 2020, 9(9), 2787; https://doi.org/10.3390/jcm9092787 - 28 Aug 2020

Cited by 19 | Viewed by 5410

Abstract

Integrated care is regarded as a key for care delivery to persons with chronic long-term conditions such as Parkinson’s disease. For persons with Parkinson’s disease, obtaining self-management support is a top priority in the context of integrated care. Self-management is regarded as a crucial competence in chronic diseases since the affected persons and their caregivers inevitably take up the main responsibility when it comes to day-to-day management. Formal self-management education programs with the focus on behavioral skills relevant to the induction and maintenance of behavioral change have been implemented as a standard in many chronic long-term conditions. However, besides the example of the Swedish National Parkinson School, the offers for persons with Parkinson’s disease remain fragmented and limited in availability. Today, no such program is implemented as a nationwide standard in Germany. This paper provides (1) a systematic review on structured self-management education programs specifically designed or adopted for persons with Parkinson’s disease, (2) presents the Swedish National Parkinson School as an example for a successfully implemented nationwide program and (3) presents a concept for the design, evaluation and long-term implementation of a future-orientated self-management education program for persons with Parkinson’s disease in Germany. Full article

(This article belongs to the Special Issue Integrated Care and Network Formation for the Treatment of Parkinson’s Disease and Other Movement Disorders)

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22 pages, 1731 KiB

Open AccessArticle

Building a Parkinson-Network–Experiences from Germany

by Marlena van Munster, Lars Tönges, Kai F. Loewenbrück, Tobias Warnecke and Carsten Eggers

J. Clin. Med. 2020, 9(9), 2743; https://doi.org/10.3390/jcm9092743 - 25 Aug 2020

Cited by 10 | Viewed by 3041

Abstract

Parkinson’s disease is a complex neurodegenerative disease that can be best treated with a multi-disciplinary care approach. Building care networks has been shown as a useful tool to facilitate the integration of care services and improve outcomes for patients and care providers. However, experiences and practices relating to building a network are very limited in the field of Parkinson’s disease. This paper portrays existing Parkinson networks in Germany. With the help of a standardized template, description of networks and their building-blocks, so-called modules, were collected from all over Germany. Modules were rated in terms of their expected benefit and the required effort when implementing them, with the help of an expert survey. The rating showed that some modules were perceived as more important than others, but all modules were recognized as beneficial for patients and care providers. Overall, the German experience shows that building a Parkinson network facilitates the integration of care and provides a benefit to all stakeholders involved. Full article

(This article belongs to the Special Issue Integrated Care and Network Formation for the Treatment of Parkinson’s Disease and Other Movement Disorders)

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10 pages, 2274 KiB

Open AccessArticle

Hospitalization Rates and Comorbidities in Patients with Progressive Supranuclear Palsy in Germany from 2010 to 2017

by Maria Angela Samis Zella, Dirk Bartig, Lennard Herrmann, Gesine Respondek, Günter Höglinger, Ralf Gold, Dirk Woitalla, Christos Krogias and Lars Tönges

J. Clin. Med. 2020, 9(8), 2454; https://doi.org/10.3390/jcm9082454 - 31 Jul 2020

Cited by 5 | Viewed by 2550

Abstract

Progressive supranuclear palsy (PSP) belongs to the disease spectrum of Parkinsonian syndromes. Due to the chronic and progressive neurodegenerative course of the disease, PSP patients often have to be hospitalized to undergo diagnostic and therapeutic measures. The dynamics and characteristics of PSP inpatient treatment in Germany have not been investigated thus far. The current study analyzed trends of inpatient treatment in Germany for the years 2010–2017 based on the German DRG statistics (“diagnostic-related groups”) in the category G23.- (other degenerative diseases of the basal ganglia) and with special focus on PSP (G23.1). Inpatient case numbers of the G23.- category comprised a total of 21,196 patients from 2010–2017, whereas the PSP subcategory (G23.1) amounted to 10,663 cases. In the analyzed time period, PSP patient numbers constantly increased from 963 in 2010 to 1780 in 2017 with yearly growth rates of up to 20%. Similar trends were observed for other Parkinsonian syndromes such as multiple system atrophy (MSA). Differentiating PSP inpatients by gender demonstrated a higher proportion of males (55–60%) in comparison to female patients for the entire observation period. The average age of hospitalized PSP patients over these years was between 72.3 and 73.4 years without relevant differences for gender. The most common comorbidities consisted of cardiovascular, neurological, muscular and urological disorders. In summary, the analysis demonstrates that PSP patients are increasingly hospitalized in Germany and the current concepts of stationary care have to differentiate standard practices for Parkinson’s disease (PD) to also address the needs of patients with PSP and other Parkinsonian syndromes. Full article

(This article belongs to the Special Issue Integrated Care and Network Formation for the Treatment of Parkinson’s Disease and Other Movement Disorders)

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17 pages, 1490 KiB

Open AccessArticle

The Impact of Korean Medicine Treatment on the Incidence of Parkinson’s Disease in Patients with Inflammatory Bowel Disease: A Nationwide Population-Based Cohort Study in South Korea

by Hyeonseok Noh, Jeongju Jang, Seungwon Kwon, Seung-Yeon Cho, Woo-Sang Jung, Sang-Kwan Moon, Jung-Mi Park, Chang-Nam Ko, Ho Kim and Seong-Uk Park

J. Clin. Med. 2020, 9(8), 2422; https://doi.org/10.3390/jcm9082422 - 28 Jul 2020

Cited by 6 | Viewed by 2969

Abstract

We aimed to investigate the association between Korean medicine (KM) treatment and the risk of Parkinson’s Disease (PD) in patients with inflammatory bowel disease (IBD) in South Korea. This study analyzed data from the National Health Insurance Service-Senior cohort in South Korea. The 1816 IBD patients enrolled in the analysis comprised 411 who received only conventional treatment (monotherapy group) and 1405 who received both conventional and KM treatments (integrative therapy group). The risk of PD in patients with IBD was significantly lower in the integrative therapy group than in the monotherapy group after adjusting for confounding variables (adjusted hazard ratio (HR), 0.56; 95% confidence interval (CI) = 0.34–0.92). In the mild Charlson Comorbidity Index (CCI) group, the risk of PD in patients with IBD in the integrative therapy group was 0.39 times lower (adjusted HR, 95% CI = 0.20–0.77) than that in the monotherapy group. However, there was no significant difference in the risk of PD in patients with IBD between the integrative therapy and monotherapy groups among individuals with severe CCI (adjusted HR, 0.90; 95% CI = 0.41−1.96). IBD patients are at a decreased risk of PD when they receive integrative therapy. KM treatment may prevent PD in IBD patients. Full article

(This article belongs to the Special Issue Integrated Care and Network Formation for the Treatment of Parkinson’s Disease and Other Movement Disorders)

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10 pages, 2852 KiB

Open AccessArticle

Quickcard-Based Approach to Guiding Specific Nonpharmacological Treatments in a German Parkinson’s Network

by Linda Kerkemeyer, Katharina Achtert, Inga Claus, Svenja Happe, Jeannette Overbeck, Nadine Kleen, Anja Palesch, Clara Schmuck, Sabrina Krouß, Jürgen Perick, Luisa Depenbrock, Michael Nagel, Frank Siebecker, Olaf Rose and Tobias Warnecke

J. Clin. Med. 2020, 9(7), 2272; https://doi.org/10.3390/jcm9072272 - 17 Jul 2020

Cited by 11 | Viewed by 2989

Abstract

Interdisciplinary care has been shown to be effective at optimizing the treatment of patients with Parkinson’s disease. An optimized collaboration between the various healthcare providers involved in the treatment process facilitates successful care. One of the main shortcomings in the German healthcare system is the limited and unstandardized communication between practitioners. The Parkinson’s network Münsterland+ (PNM+) is an interdisciplinary network of medical and non-medical experts involved in the treatment of Parkinson’s patients: neurologists, physiotherapists, occupational therapists, speech therapists, psychologists, Parkinson’s nurses, pharmacists, patients, and relatives. The PNM+ elaborates guideline-based therapy recommendations, provided as so-called “Quickcards”. Thereby, the communication of the treating neurologist and therapists is based on a coordinated feedback system and suggestions to adequately select and, if necessary, adjust the therapy. In the German healthcare system, with its fragmented structures, the PNM+ and its activities have been shown to enhance integration of the healthcare providers and thereby optimize the care of Parkinson’s disease patients. Future research should evaluate the effects and cost-effectiveness. Full article

(This article belongs to the Special Issue Integrated Care and Network Formation for the Treatment of Parkinson’s Disease and Other Movement Disorders)

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15 pages, 952 KiB

Open AccessArticle

Parkinson’s Disease Multimodal Complex Treatment (PD-MCT): Analysis of Therapeutic Effects and Predictors for Improvement

by Elke Hartelt, Raphael Scherbaum, Manuel Kinkel, Ralf Gold, Siegfried Muhlack and Lars Tönges

J. Clin. Med. 2020, 9(6), 1874; https://doi.org/10.3390/jcm9061874 - 16 Jun 2020

Cited by 15 | Viewed by 4704

Abstract

Parkinson’s disease Multimodal Complex Treatment (PD-MCT) is a multidisciplinary inpatient treatment approach that has been demonstrated to improve motor function and quality of life in patients with Parkinson’s disease (PD). In this study, we assessed the efficacy of PD-MCT and calculated predictors for improvement. We performed a prospective analysis in a non-randomized, open-label observational patient cohort. Study examinations were done at baseline (BL), at discharge after two-weeks of inpatient treatment (DC) and at a six-week follow-up examination (FU). Besides Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) III as a primary outcome, motor performance was measured by the Timed Up-and-Go (TUG), the Berg Balance Scale (BBS) and the Perdue Pegboard Test (PPT). Until DC, motor performance improved significantly in several parameters and was largely maintained until FU (MDS-UPDRS III BL-to-DC: −4.7 ± 1.2 (SE) p = 0.0012, BL-to-FU: −6.1 ± 1.3 p = 0.0001; TUG BL-to-DC: −2.5 ± 0.9 p = 0.015, BL-to-FU: 2.4 ± 0.9 p = 0.027; BBS BL-to-DC: 2.4 ± 0.7 p = 0.003, BL-to-FU: 1.3 ± 0.7 p = 0.176, PPT BL-to-DC: 3.0 ± 0.5 p = 0.000004, BL-to-FU: 1.7 ± 0.7 p = 0.059). Overall, nontremor items were more therapy responsive than tremor items. Motor complications evaluated with MDS-UPDRS IV occurred significantly less frequent at DC (−1.8 ± 0.5 p = 0.002). Predictor analyses revealed an influence of initial motor impairment and disease severity on the treatment response in different motor aspects. In summary, we demonstrate a significant positive treatment effect of PD-MCT on motor function of PD patients which can be maintained in several parameters for an extended time period of six weeks and identify predictors for an improvement of motor function. Full article

(This article belongs to the Special Issue Integrated Care and Network Formation for the Treatment of Parkinson’s Disease and Other Movement Disorders)

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12 pages, 897 KiB

Open AccessArticle

What Determines Spontaneous Physical Activity in Patients with Parkinson’s Disease?

by Agnieszka Gorzkowska, Joanna Cholewa, Andrzej Małecki, Aleksandra Klimkowicz-Mrowiec and Jarosław Cholewa

J. Clin. Med. 2020, 9(5), 1296; https://doi.org/10.3390/jcm9051296 - 1 May 2020

Cited by 7 | Viewed by 3244

Abstract

Physical activity (PA) is a factor that may have an influence on the symptoms of Parkinson’s disease (PD). The aim of this study was to identify the potential determinants of spontaneous PA in a PD patient group. A total of 134 PD patients aged 65.2 ± 9.2 years with a Hoehn–Yahr scale score ≤4 and a Mini Mental State Examination (MMSE) score ≥24 were examined. For the study’s purposes, the authors analyzed age, sex, education, history of PD, dopaminergic treatment, the severity of PD symptoms using Unified Parkinson’s Disease Rating Scale (UPDRS), and Hoehn–Yahr scale. Additionally, all participants were evaluated through a set of scales for specific neuropsychiatric symptoms including depression, anxiety, apathy, fatigue, and sleep disorders. A linear regression analysis was used with backward elimination. In the total explanatory model, for 12% of the variability in activity (R² = 0.125; F(16.133) = 2.185; p < 0.01), the significant predictor was starting therapy with the dopamine agonist (DA) (β= 0.420; t= 4.068; p = 0.000), which was associated with a longer duration of moderate PA. In the total explanatory model, for more than 13% of the variance in time spent sitting (R² = 0.135; F(16.130) = 2.267; p < 0.01), the significant predictors were secondary education and the results of the UPDRS. The patients with secondary and vocational education, those starting treatment with DA and those with a less severe degree of Parkinson’s symptoms (UPDRS), spent less time sitting in a day. It is possible to identify determinants of spontaneous PA. It may elucidate consequences in terms of influence on modifiable conditions of PA and the proper approach to patients with unmodifiable PA factors. Full article

(This article belongs to the Special Issue Integrated Care and Network Formation for the Treatment of Parkinson’s Disease and Other Movement Disorders)

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13 pages, 1856 KiB

Open AccessArticle

Tc-99m TRODAT-1 SPECT is a Potential Biomarker for Restless Leg Syndrome in Patients with End-Stage Renal Disease

by Yi-Chou Hou, Yu-Ming Fan, Ya-Ching Huang, Ruei-Ming Chen, Cheng-Hsu Wang, Yi-Te Lin, Tzung-Hai Yen, Kuo-Cheng Lu and Yuh-Feng Lin

J. Clin. Med. 2020, 9(3), 889; https://doi.org/10.3390/jcm9030889 - 24 Mar 2020

Cited by 2 | Viewed by 3587

Abstract

Rationales: Restless leg syndrome (RLS) is a common complication in patients with end-stage renal disease (ESRD). However, there is a lack of biomarkers linking uremic RLS to dopaminergic neurons. Previous studies demonstrated that Tc-99m TRODAT-1 SPECT was a biomarker for RLS but the correlation between the physiologic parameter was lacking. Methods: Overall, 32 patients were enrolled in the study and divided into the following 3 groups: (1) control (n = 13), (2) ESRD without RLS (n = 8) and (3) ESRD with RLS (n = 11). All patients had a clinical diagnosis of RLS and received Tc-99m TRODAT-1 SPECT. A subgroup analysis was performed to compare differences between the control and ESRD with RLS groups. Tc-99m TRODAT-1 SPECT was performed and activities in the striatum and occipital areas were measured using manually delineated regions of interest (ROIs) by an experienced nuclear medicine radiologist who was blinded to clinical data. Results: The total ratio of Tc-99m TRODAT SPECT was lower in the ESRD with RLS group (p = 0.046). The uptake ratio of TRODAT negatively correlated with serum parathyroid hormone (r = −0.577, p = 0.015) and ferritin (r = −0.464, p = 0.039) concentrations. However, the uptake positively correlated with the hemoglobin concentration (r = 0.531, p = 0.011). The sensitivity and specificity of the total TRODAT ratio for predicting RLS in the overall population were 95.0% and 67.7%, respectively, at a cutoff value of 0.980 (area under the curve of receiver operating characteristic curve was 0.767, p = 0.024). Conclusion: In patients with ESRD and RLS, Tc-99m TRODAT might be a potential biomarker. Dysregulated hemoglobin, serum parathyroid hormone and serum ferritin concentrations might influence the uptake of the TRODAT ratio. Full article

(This article belongs to the Special Issue Integrated Care and Network Formation for the Treatment of Parkinson’s Disease and Other Movement Disorders)

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15 pages, 453 KiB

Open AccessArticle

Consensus-Based Recommendations for Advance Directives of People with Parkinson’s Disease in Regard to Typical Complications by German Movement Disorder Specialists

by Martin Klietz, Johanna M. Berndt, Florian Wegner, Nils Schneider, Günter U. Höglinger, Carsten Eggers and Stephanie Stiel

J. Clin. Med. 2020, 9(2), 449; https://doi.org/10.3390/jcm9020449 - 6 Feb 2020

Cited by 8 | Viewed by 3127

Abstract

A huge proportion of people with Parkinson’s disease (PwP) in Germany have written an advance directive (AD). However, the content of these forms in regard to specific Parkinson’s disease (PD)-related complications is rather low. There is an urgent need to specify ADs of PwP and consequently to improve decision-making concerning end-of-life aspects for affected patients. Evidence- and consensus-based PD-specific recommendations for ADs might help to close this gap. A Delphi study with two online Delphi rounds was initiated. Initial recommendations were built on findings from previous studies and derived from evidence-based literature. Consensus on recommendations was defined as ≥80% concordance regarding clarity of formulated aspects and relevance for clinical practice. A total of 22 experts (15.2% response rate) predominantly from the workgroup ‘neuro-palliative care’ in Germany performed two Delphi rounds. Consensus was achieved for 14 of 24 initially presented recommendations. Recommendations relating to dopaminergic therapy as well as to non-oral therapy options were considered important by the expert panel. The recommendations should be taken into account when developing and giving advice on ADs for PwP. Health professionals should be trained in counselling ADs of PwP and in integrating these recommendations in ADs during the disease course of PD. Full article

(This article belongs to the Special Issue Integrated Care and Network Formation for the Treatment of Parkinson’s Disease and Other Movement Disorders)

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Review

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12 pages, 580 KiB

Open AccessReview

Specialized Staff for the Care of People with Parkinson’s Disease in Germany: An Overview

by Tino Prell, Frank Siebecker, Michael Lorrain, Lars Tönges, Tobias Warnecke, Jochen Klucken, Ingmar Wellach, Carsten Buhmann, Martin Wolz, Stefan Lorenzl, Heinz Herbst, Carsten Eggers and Tobias Mai

J. Clin. Med. 2020, 9(8), 2581; https://doi.org/10.3390/jcm9082581 - 10 Aug 2020

Cited by 20 | Viewed by 5395

Abstract

Access to specialized care is essential for people with Parkinson´s disease (PD). Given the growing number of people with PD and the lack of general practitioners and neurologists, particularly in rural areas in Germany, specialized PD staff (PDS), such as PD nurse specialists and Parkinson Assistants (PASS), will play an increasingly important role in the care of people with PD over the coming years. PDS have several tasks, such as having a role as an educator or adviser for other health professionals or an advocate for people with PD to represent and justify their needs. PD nurse specialists have been established for a long time in the Netherlands, England, the USA, and Scandinavia. In contrast, in Germany, distinct PDS models and projects have been established. However, these projects and models show substantial heterogeneity in terms of access requirements, education, theoretical and practical skills, principal workplace (inpatient vs. outpatient), and reimbursement. This review provides an overview of the existing forms and regional models for PDS in Germany. PDS reimbursement concepts must be established that will foster an implementation throughout Germany. Additionally, development of professional roles in nursing and more specialized care in Germany is needed. Full article

(This article belongs to the Special Issue Integrated Care and Network Formation for the Treatment of Parkinson’s Disease and Other Movement Disorders)

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12 pages, 742 KiB

Open AccessReview

Recommendations for Standards of Network Care for Patients with Parkinson’s Disease in Germany

by Tino Prell, Frank Siebecker, Michael Lorrain, Carsten Eggers, Stefan Lorenzl, Jochen Klucken, Tobias Warnecke, Carsten Buhmann, Lars Tönges, Reinhard Ehret, Ingmar Wellach and Martin Wolz

J. Clin. Med. 2020, 9(5), 1455; https://doi.org/10.3390/jcm9051455 - 13 May 2020

Cited by 20 | Viewed by 4244

Abstract

Although our understanding of Parkinson’s disease (PD) has improved and effective treatments are available, caring for people with PD remains a challenge. The large heterogeneity in terms of motor symptoms, nonmotor symptoms, and disease progression makes tailored individual therapy and individual timing of treatment necessary. On the other hand, only limited resources are available for a growing number of patients, and the high quality of treatment cannot be guaranteed across the board. At this point, networks can help to make better use of resources and improve care. The working group PD Networks and Integrated Care, part of the German Parkinson Society, is entrusted to convene clinicians, therapists, nurses, researchers, and patients to promote the development of PD networks. This article summarizes the work carried out by the working group PD Networks and Integrated Care in the development of standards of network care for patients with PD in Germany. Full article

(This article belongs to the Special Issue Integrated Care and Network Formation for the Treatment of Parkinson’s Disease and Other Movement Disorders)

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