How Is FND Managed in Australian Hospitals? A Multi-Site Study Conducted on Acute Inpatient and Inpatient Rehabilitation Wards 2023 Petrie et al

Background
Successful management for functional neurological disorder (FND) requires multidisciplinary involvement starting with providing a definitive diagnosis.

Objectives
To observe clinical management of patients with FND during hospital admission.

Methods
A prospective observational study was conducted over six Australian hospitals over a 4-month period. Data collected included patient demographics, communication of the diagnosis of FND, access to the multidisciplinary team, hospital length of stay (LOS), and emergency department (ED) presentations.

Results
A total of 113 patients were included. Median LOS was 6 (interquartile range, 3–14) days. Thirty-five (31%) presented to ED with 9 (8%) re-presenting two or more times after hospital discharge. Total hospital utilization cost was AUD$3.5million. A new diagnosis was made in 82 (73%) patients. Inpatient referrals were made to neurology (81, 72%), psychology (29, 26%), psychiatry (27, 24%), and physiotherapy (100, 88%). Forty-four (54%) were not told of the diagnosis. Twenty (24%) did not have their diagnosis documented in their medical record. Of the 19 (23%) not reviewed by neurology on non-neurosciences wards, 17 (89%) did not have their diagnosis communicated and 11 (58%) did not have it documented. Twenty-five (42%) referred to neurology were not provided with a diagnosis.

Conclusions
Current gaps in service provision during inpatient hospital admissions in Australia include low rates of communication of a diagnosis, particularly when patients are not located on a neurosciences ward, and limited and variable access to inpatient multidisciplinary teams. Specialized services are needed to improve education, clinical pathways, communication, and health outcomes while reducing healthcare system costs.

Paywall, https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mdc3.13718

 

I'm a bit confused, as I can't access the full article (and also the conflicts of interest they note are at the end of it), what they think is 'managing FND' from this.

I was initially anticipating given a scan of the measures that it would be seeing whether diagnosis and treatment improved people's health and quality of life - with whatever requisite measures and indicators of this. But I'm not confident the timing of any of these measures relates to that at all. Does 'management' for this condition effectively end in diagnosis of FND, and is it about doing that earlier to save on e.g. investigations and healthcare that then wouldn't be given once everyone knows it is FND - or am I missing the 'treatment' or 'management' part? and whether any reductions in trips are due to either of those actually helping someone need it less, or them just being taught there is nothing for them?