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Toronto (Nov. 25, 2019) – A model of care piloted at the University Health Network (UHN)'s Otolaryngology, Head & Neck Surgery Clinic, and the only one of its kind in Canada, is showing to be most effective for the successful treatment of chronic dizziness.
Patients treated within this model, which integrates nursing and psychiatry (INaP) support with an interdisciplinary clinical team, were found to have greater reduction in dizziness-related disability as compared to patients treated by interdisciplinary team only. The results of the evaluation were published today in
The Laryngoscope along with a second paper describing the INaP model.
"This innovative model, where psychiatric support is embedded within interdisciplinary patient care from the beginning while also providing access to a nurse clinician has greatly contributed to improved outcomes for our patients," says Dr. Philip Gerretsen, a clinician-scientist at UHN who studies the intersection of medical conditions with mental health issues and is lead author of both papers.
"Patients frequently feel lost, alone and unsupported with debilitating symptoms of dizziness and imbalance, which impair their ability to work, socialize and maintain a reasonable quality of life," he continues. "This approach attempts to address these inadequacies so patients feel supported and cared for by an available, accessible team that works toward addressing both patients' physical and mental health needs. Encouragingly, given the scarcity of healthcare resources to treat chronic dizziness, INaP is also able to serve a higher volume of patients than the traditional approach to care."
Dizziness and imbalance are among the most common complaints in medicine, affecting approximately 20 per cent to 30 per cent of patients worldwide and contributing to reduced quality of life. Dizziness is characterized as an abnormal sense of disequilibrium or self-motion described as spinning, rocking, falling, tilting, or floating which can result from either vestibular or non-vestibular disorders, as well as have either psychosomatic or other psychiatric contributing factors.
In UHN's INaP model, an interdisciplinary healthcare team consisting of a neurotologist, neurologist, vestibular physiotherapist, psychiatrist, and nurse clinician together provide an assessment which includes both a neurotological and psychiatric evaluation.
The nurse clinician acts as the hub of care during this process, providing education, treatment guidance, psychotherapeutic support, and care coordination. This support, whether in-person, by phone, email or other electronic platform, helps address the psychosocial and attachment needs of patients and their families/caregivers that can arise due to the patient's illness.
In most current models of care, dizziness is treated via an "assess and refer" process where a patient is evaluated by one specialist after another with a focus on the vestibular/non-vestibular causes of their condition. Mental health evaluation is left for later consideration, often resulting in persistence of the patient's dizziness.
Even in clinics where an interdisciplinary treatment approach has been adopted, the lack of integrated psychiatric and nurse clinician support means that the complexities that result from overlapping physical or psychiatric symptoms associated with these disorders can be overlooked.
"Our research shows that this model better aligns available resources as efficiently as possible to support our patients' functional recovery," says Dr. Gerretsen. "As we continue to recognize the role of mental health in many chronic diseases, this is a model to be considered in treating them."
University Health Network consists of Toronto General, recently voted one of the Top 10 Hospitals in the World according to Newsweek Magazine, and Toronto Western Hospital, the Princess Margaret Cancer Centre, Toronto Rehabilitation Institute, and the Michener Institute of Education at UHN. The scope of research and complexity of cases at University Health Network has made it a national and international source of discovery, education and patient care. It has the largest hospital-based research program in Canada, with major research in cardiology, transplantation, neurosciences, oncology, surgical innovation, infectious diseases, genomic medicine and rehabilitation medicine. University Health Network is a research hospital affiliated with the University of Toronto.
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