A transdisciplinary, evidence-based model of ambulatory care may reduce emergency department presentations for patients with functional neurological disorder: A retrospective pre-post-intervention service evaluation

Abstract

Background

Functional neurological disorder (FND) results in high levels of physical and psychological disability, significant healthcare costs due to delayed diagnosis, repeated healthcare visits and medical investigations. New evidence-based models of care, involving multidisciplinary input centered around the biopsychosocial model, emphasizing each patient's strengths and promoting self-management, have been shown to improve patient outcomes and may reduce healthcare costs.

Aim

To investigate the effect of a new evidence-based, transdisciplinary model of ambulatory care for FND on the frequency of presentations for FND-related symptoms to emergency departments (EDs) before, during and after treatment completion.

Methods

A retrospective service evaluation was undertaken. An outpatient transdisciplinary team provided either a comprehensive rehabilitation program to participants (lasting a mean of 12.1 weeks) or an education-only program (lasting a mean of 3.0 weeks).

Results

Twenty-nine participants (22 [75.9 %] female, mean [SD] age 42.9 [17.9] years) who received 38.8 [26.6] occasions of service were included in analyses. Twenty-four were assessed as requiring and subsequently received the comprehensive rehabilitation program and 5 were deemed to require and received the education-only program. The mean (SD) number of ED presentations significantly decreased from 1.3 (1.8) pre-program to 0.1 (0.4) during the program (p = 0.000) and to 0.1 (0.4) post-program (p = 0.001).

Conclusions

A reduction in the number of FND-related presentations to ED was found after the provision of a transdisciplinary model of ambulatory care, provided in an out-patient setting. However, the nature of the study means that cause/effect cannot be proved.