Sharing best practice on disease modifying treatments for MS

1. Samantha Colhoun
CNS – MS
Queen Elizabeth Hospital - Birmingham

2.  Cover large area of Birmingham for 1st
line DMT’s
 Provide regional Tysabri, Lemtrada and
Fingolimod services

3.  Initially developed DMT discussion groups due to
large waiting list
 Capacity issues with clinics

4.  Team philosophy – education is the key to
adherence

5.  6 - 7 groups held each month
 Separate groups for 1st
line DMT’s, Lemtrada and
Fingolimod
 4 – 6 patients attend each group
 Discussion group lasts up to 2 hours (inc
screening)
 Some individuals will not be suitable and seen in
clinic ie language barrier, cognition, anxiety

6. VARK LEARNING STYLE

7.  Patients are invited to attend with someone
 Written information sent with invitation letter
◦ DMT booklet (MS Trust) for 1st
line or
◦ Fingolimod / Lemtrada patient pack
◦ Directed to MS Decisions

8.  Screening booklet completed:
◦ Blood tests and other investigations
◦ Previous DMT’s
◦ Allergies
◦ Current medications
◦ Previous medications (ie immunosuppressant's, caridac)

9.  Screening booklet completed:
◦ Supplementary therapies
◦ Any other conditions (current or previous) ie cancers
◦ Contraception
◦ Baseline obs (BP, pulse and temp)

10.  A power point presentation of the therapies
available
 After each drug discussed – practical
demonstration of devices (injectables)
 Patients are encouraged to handle the devices

11.  Overview of the therapies inc:
◦ Mode of action
◦ Side effects
◦ Monitoring
◦ Initiation
◦ Delivery / training / administration of therapy
◦ Other medications
◦ Relapses and steroids
◦ Pregnancy
◦ Travel
◦ Supplementary therapies
◦ Stopping criteria

12.  Patient (and relative/friend) have one to one with
MS nurse
 If patient undecided they will either:
◦ Ring when made decision
◦ Attend further clinic app to discuss

13.  Check list is signed by both patient and MS nurse,
copy given to patient
 Outlines points covered in the presentation
 To ensure their understanding of the process
including adherence / stopping criteria

14.  Patients are encouraged to think about:
◦ Lifestyle
◦ Work
◦ Children
◦ Religion
◦ Diet limitations: ie vegetarian, PEG
◦ Managing side effects
◦ Adherence

15.  Audit every 12 – 24 months
 Results have always been positive
◦ Duration of session
◦ Information provided

16.  Patient feedback
Small enough
group to ask
questions
Straight forward and
understandable
Relaxed
atmosphere
People asked
useful questions
that I had not
thought of