[Patient care in a hospital based unit for treating Parkinson's disease and movement disorders: a 3-year prospective...

A register covering a 3-year period (1991-1993) was opened for all patients attending a Parkinson's disease and movement disorder clinic which has been running for 15 years in a reference hospital covering a population of 629,555 in Madrid. During the last 2 years, all 5 neurologists serving the reference health area joined to the hospital on a part-time basis. A total of 764 patients were seen during the study period, 56.2% of whom were follow-up patients. About half of the later (49%) were suffering from Parkinson's disease (PD), follow-up duration averaging 4.7 +/- 4.4 years. Follow-up in dystonias (11.8%) and choreas (8.1%) cases was similar and averaged 5.0 +/- 4.2 and 4.5 +/- 4.2 years, respectively. Out of 334 new referrals 192 were new parkinsonism patients, half of them (48.4%) with secondary parkinsonism, particularly drug-induced parkinsonism (32.2%). Incorporation of neurologists serving the reference health area to hospital activities correlated to a decrease in secondary parkinsonism referrals, a slight drop in de novo PD patients, but not in an earlier detection of new PD cases. We conclude that a monographic out-patient clinic may benefit from sharing activities with neurologists serving the referral health area, and from improving the neurological education of general practitioners.