Identifying Standards for Timely Intervention and Treatment in Multiple Sclerosis

Prompt diagnosis and timely intervention is key in improving outcomes for patients with multiple sclerosis (MS). A new study in Multiple Sclerosis Journal outlines quality standards for timely, brain health—focused MS care.

The researchers convened a panel of MS specialist neurologists to define time frames that reflect minimum, good, and high care standards.

“Irreversible neural damage and cell loss occur from disease onset when the frequency of inflammatory attacks on the central nervous system is often greatest,” the authors explained. However, they added that “Time to a diagnosis of MS is often protracted, delaying access to specialist healthcare advice and treatment initiation.”

A total of 21 neurologists from 19 countries participated and identified core, achievable, and aspirational levels of care. Core care is a minimum standard that should be achieved by most MS teams worldwide, regardless of the local healthcare system. Achievable care reflects good standard of care and is a realistic target for most MS teams. Aspirational care is the standard for high-quality care and might be achieved by only a few MS teams as the local healthcare system allows.

There were 3 stages in the process: establishing principles of timely care, setting time frames, and achieving consensus. To establish principles of timely care, the participants grouped time-related principles from the policy report Brain health: time matters in multiple sclerosis into 5 domains: onset of symptoms; referral and diagnosis; lifestyle and comorbidities; initiating disease-modifying therapy (DMT); and monitoring.

Then, the participants independently proposed standards for the timing of key events and final time frames were determined based on the 75th percentile values achieved for each core, achievable, and aspirational standard. Finally, a consensus was reached by voting.

The 21 neurologists reached a consensus on the majority of core (25 out of 27), achievable (25 out of 27) and aspirational (22 out of 27) time frames. They agreed that uncomplicated MS should be diagnosed within 3 months of symptoms first being reported and diagnosis within 1 month can be expected at the best clinics. The participants also reached a consensus that DMT eligibility should be assessed within 6 weeks of diagnosis at all clinics and appropriate DMT should be offered within 2 months.

The participants also agreed that routine check-ups should take place at least annually and routine annual magnetic resonance imaging was achievable for most clinics.

“We know these standards will be challenging for all of us to meet, particularly within current healthcare climates,” the authors concluded. “However, we believe this is no justification for disregarding timely care. These standards provide an opportunity to identify strengths and weaknesses, focus problem-solving and highlight areas requiring investment.”

Reference

Hobart J, Bowen A, Pepper G, et al. International consensus on quality standards for brain health-focused care in multiple sclerosis. [published online November 1, 2018]. Mult Scler. doi: 10.1177/1352458518809326.