Australia’s functional neurological symptom disorder clinics are underresourced and vary greatly in their models of care, a survey suggests, prompting calls for a more coordinated approach and the development of national clinical standards.
Researchers surveyed clinicians at services across Australia and New Zealand about the details of their service delivery, including their clinical model, referral sources, criteria, demand, staffing, interventions, data collection and funding.
Of the 16 clinics included, 12 were in capital cities and four in regional centres.
Three clinics had a paediatric focus with the remaining clinics set up for adults.
Most clinics saw a wide range of FND symptoms, including weakness/paralysis, abnormal movements, speech, seizures/attacks, sensory disturbances, and mixed symptoms. They also saw patients with primary functional swallowing disorders and patients with primary functional cognitive symptoms.
Exclusion criteria were common and varied widely between ongoing litigation or insurance claims, primary issues of chronic pain, gastrointestinal concerns, fatigue and the presence of an acute psychotic disorder.
While all clinics accepted referrals from neurologists, other sources of referrals included psychiatrists, GPs, other medical specialists and allied health clinicians.
Some clinics relied on geographical boundaries when it came to taking on patients, such as only seeing patients within their hospital, within their local health area or within their state or region.
As for referrals, half of the clinics reported that the number they received exceeded their capacity, with some increasing their thresholds to provide a sustainable service and avoid excessive wait-times that could negatively impact on patients.
Despite this, most reported wait times of more than three months.
In terms of delivery, almost all clinics ran as outpatient services.
Twelve clinics (75%) used multidisciplinary teams, although clinicians greatly varied. They included psychiatrists (87%), psychologists (80%), physiotherapists (60%) and neurologists (47%) as well as rehabilitation physicians, paediatricians, occupational therapists, speech therapists, nurses and social workers.
All clinics collected data as part of routine clinical care but did so for different reasons, which included for research purposes, for service development and funding, and for clinical governance and quality improvement.
Most (69%) clinics were publicly funded – five by Medicare billing, five from other public funding and one from both – while three clinics (19%) were funded by research grants and two clinics (13%) were privately funded.
Coping with patient demand and lack of funding appeared to be the biggest challenges facing the majority of clinics.
Other challenges identified included difficulty accessing allied health staff; organisational rules around referral criteria (such as requiring movement disturbance or engagement with rehabilitation services for access to care); clinic space; and limited engagement with Indigenous populations and rural areas.
The researchers raised some concern over their finding that FND clinics appeared to be concentrated predominantly in metropolitan areas as well as the considerable variation in their referral sources, clinical data collection, and models of care.
“This heterogeneity may pose a further barrier to patients accessing care, given the challenges involved in navigating already complex healthcare systems. While aspects of this heterogeneity might serve local need, it also raises questions about optimal standards and referral pathways, and limits capacity for quality improvement and multi-centre clinical trials,” they wrote.
They said further resources and efforts to increase coordination between clinics, along with development of national guidelines, would help patients access care.
The findings were published in the Journal of Clinical Neuroscience [link here].