3P Program for Parkinson Patients
The 3P Program is a proactive care management program, with outcome-driven care plans adapted to the real needs of the patients. This means that we do not only consider just the symptoms, we consider the needs of patients and caregivers. All dimensions of the patient’s quality of life are considered: physical, psychological, social and essential. For this, different channels are used and work is done in a joint and coordinated manner with the reference Hospitals.
3P refers to 3 main axes:
– Preventing: Prevent and delay disease progression
– Predicting: Predict who and when the patient will need care and attention.
– Prescribing: Identify the treatment needs that can be prescribed to the patient.
3P Program is based on two core tasks:
- Evaluation and monitoring of the needs of patients in relation to their treatment
- Care plans adapted and proactive that allow correcting or reporting the evolution of the patient in relation to their treatment.
To achieve these objectives, the program is based on 5 pillars:
– Care coordination: between Hospital and 3P Nurse
– Patient navigation, proactively guidance and support for patients
– Information provision, Providing PD-related information in oral, written or other form
– Early detection of signs and symptoms through proactive monitoring, the timely detection of the first changes in signs or symptoms, allowing for pre-emptive interventions to prevent further worsening of problems and to avoid complications that might lead to emergency department visits, hospital admission and use of unnecessary resources.
– Process monitoring, routine review and evaluation of the care management process regarding adherence to care plans
It is an “agnostic” program, that is, it is a patient-centered program, independent of the type of treatment followed by the patient.
The neurologist and the hospital’s Neurology nurse propose to include the patient in the 3P Program. Once you accept, it is sent. The 3P Nurse contacts the patient and welcomes them, explaining what the program consists of and the next steps. She sends the patient a sensor with instructions for its use. This sensor allows monitoring different symptoms. The date of the first evaluation to be carried out in the hospital or at the patient’s home is scheduled; The assessment of the physical, psychological, social and essential needs of the person is carried out and the main outcomes (hospitalizations, Health related QoL, autonomy) are evaluated. Depending on the patient’s condition, which can be “Green” if it is ‘stable’, “Yellow” if it presents several alterations or “Red” if the patient is unstable, a personalized care plan is configured that takes their condition into account (Hoehn & Yahr). For this calculation, an algorithm is used that takes into account 10 symptoms and needs. The result of the evaluation is shared with the hospital, and joint decision-making is carried out. Depending on the care plan, a complete scheduled evaluation is carried out.