#ClinicSpeak & #BrainHealth: MS treatment practices across Europe

What can we do to improve how MS is managed in Europe? #BrainHealth #ClinicSpeak #MSBlog

The survey below shows that the practice of MSology across Europe is highly variable. This is based on many factors including resources, economics and cultural influences. The survey highlights a lot of differences in the practice of MSology, for example the interpretation of the MS diagnostic criteria and the use of DMTs according to their prescribing indication. Herein lies the problem. Variability means that pwMS are being managed differently across Europe, which is not necessarily based on the best available evidence and will almost certainly manifest with different outcomes. 

One the reasons we launched our 'Brain Health: Time is Brain' policy initiative was to address some of these imbalances. We want to smooth out variability of MS practice so that pwMS get the best possible care whomever they see. I now encourage all my patients to read the Brain Health document, preferably the full version rather than the abbreviated version, and their feedback has been unanimously positive. Knowing about how MS should be managed in the modern era helps pwMS understand and demand that they are managed well. Reading this document and being aware is called 'patient activation'. 

We are in the process of following up the policy document with the development of a continuous quality improvement tool (cQUIT) in the hope to encourage HCPs and pwMS to strive for the best MS care possible. The cQUIT may be the change agent that makes the policy document come alive and influence behaviour. I have learnt that information on its own rarely changes behaviour; you need 'carrots and sticks' to do that. 

However, this neurocentric survey below highlights a trend in the healthcare sector to look at its performance and ask the question 'Can we do better?'.  


Brain health guide for people with multiple sclerosis from Gavin Giovannoni

Fern├índez et al. Survey of diagnostic and treatment practices for multiple sclerosis in Europe. Eur J Neurol. 2017 Jan 31. doi: 10.1111/ene.13236.

BACKGROUND AND PURPOSE
: Up-to-date information is needed on the extent to which neurologists treating multiple sclerosis (MS) in Europe are integrating rapidly evolving diagnostic criteria, disease-modifying therapies and recommendations for monitoring disease activity into their clinical practice.


METHODS: A steering committee of MS neurologists used a modified Delphi process to develop case- and practice-based questions for two sequential surveys distributed to MS neurologists throughout Europe. Case-based questions were developed for radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS) and RRMS with breakthrough disease.

RESULTS: Multiple sclerosis neurologists from 11 European countries responded to survey 1 (n = 233) and survey 2 (n = 171). Respondents agreed that they would not treat the patients in the RIS or CIS cases but would treat a patient with a relatively mild form of RRMS. Choice of treatment was evenly distributed among first-line injectables and oral treatments for mild RRMS, and moved to second-line treatment as the RRMS case increased in severity. Additional results on RRMS with breakthrough disease are presented.

CONCLUSIONS: Although there was general agreement on some aspects of treatment, responses to other management and clinical practice questions varied considerably. These results, which reflect current clinical practice patterns, highlight the need for additional MS treatment education and awareness and may help inform the development of MS practice guidelines in Europe.

CoI: I am a co-author on this paper and a member of the steering committee who designed this survey.

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