Counseling Points Multiple Sclerosis - Spring 2015 - 4

Encouraging Monitoring and
Follow-up in MS Care

I

n a neurology clinic that manages approxi-

ies. Only a few patients regularly report back
or bring copies of their lab results to the clinic.

mately 200 patients with multiple sclerosis
(MS), a newly hired neurology nurse prac-

* Notes in the charts indicate that many patients
have encountered significant delays in obtaining their DMT due to difficulties getting
through the prior authorization system.

titioner (NP) is asked to review the charts of all
active patients with a diagnosis of MS, to determine if they are up-to-date with the monitoring

* When some patients have tried to refill their
medications, they are sometimes told by the
pharmacy they need a particular test first. It's
not clear from the chart whether the person
completed these steps and was able to refill
the medication.

requirements needed to ensure safe and effective
use of their disease-modifying therapies (DMTs).
This sounds like a fairly straightforward task,
so the NP begins with the practice's electronic
medical record system to see if there is a system in place for keeping track of patients' blood

This practice may sound particularly disorganized, but in fact it may be closer to the norm
than the exception. Rapid changes in the MS
therapeutic environment have demanded a much
more personalized system for initiating and following patients on their therapies.1-3 However,
increasing complexity in both reimbursement and
patient monitoring and follow-up have made it
difficult for MS care providers in most practice
settings to keep up with the demand for more
hands-on care. This is true not only in MS, but
also in other disease states such as cancer and
rheumatoid arthritis, where personalized medicine
goals are coupled with higher-cost specialty pharmaceuticals.4 In these settings, nurses face increasing challenges for communication, support, and
advocacy for patients.5
Balancing the best possible treatment outcomes
with the need to minimize complications, maximize adherence to therapy, and control costs often

test results, necessary eye exams, MRI data, etc.
Unfortunately, the amount of information entered
into this system seems to differ for each patient,
and is incomplete for many of them. The NP
starts making a list of the common problem areas
where more information or follow-up appears to
be needed:
* Some patients with MS have not had a follow-up appointment at the clinic for at least a
year.
* In some cases, it's not clear whether patients
are actually taking the most recent MS DMT
prescribed, if they ever filled the initial prescription, or if they have returned to obtain
appropriate refills.
* There is no single place to look to review
current results of safety monitoring. Patients
appear to be "on their own" to obtain most
lab tests, eye exams, and follow-up MRI studwww.counselingpoints.com

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Counseling Points Multiple Sclerosis - Spring 2015

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