Integrating the algorithm into community practice.
The success of integrating an algorithm of care for amyotrophic lateral sclerosis (ALS) into community practice depends on highlighting the benefits to patients and families and demonstrating those benefits to clinicians and service providers. The key issues in providing care for patients with ALS are the delay in establishing a diagnosis, variable access to necessary multidisciplinary services in health and social care, the need for further research to improve the prognosis, and increasing the level of information about ALS among professionals. Achieving an accurate diagnosis as soon as possible can enable focused services to be available earlier and can enable a management plan to be drawn up in anticipation of clinical deterioration. In view of the low incidence of the condition, it may be prudent to include ALS education as part of a broader neurologic educational initiative. Voluntary organizations, patients and their families, specialist liaison nurses, and pressure groups can all be powerful influences on the provision of health care and public/professional education. Adoption of the algorithm into community practice is likely to be a gradual process, involving a number of different approaches. The only general guidance is to carefully consider the key messages and their intended target audiences.