CC24
Audit of Multiple Sclerosis Practice Against Nice Guidelines 2014
Multiple sclerosis (MS) affects approximately 100,000 people in the UK. In 2014, NICE produced MS guidelines to replace the NICE clinical guideline (2003) and covers diagnosis, information and support, treatment of relapse and management of MS related symptoms. After the NICE guideline of 2003, there was an audit of the Sunderland MS Service of time taken between initial referral to neurological services and diagnosis. This audit measures the time between suspected MS, confirmed MS, and the time taken between a patient being eligible for Disease Modifying Therapy and receiving it.
Objectives:
To determine the time taken from an appointment with a Neurologist to receiving a confirmed diagnosis; and the time taken from when a patient becomes eligible for DMT therapy to receiving their chosen DMT treatment
Methods:
A database of patients at Sunderland Hospital with a diagnosis of multiple sclerosis is kept. This retrospective study looked back at the records of these patients, including outpatient records, MRI records and outpatient clinic letters. 25 patients who had made contact with the neurological services from 9.6.09 to 22.1.14 had their notes analysed to determine the time taken from an appointment with a Neurologist with suspected MS to receiving a confirmed diagnosis; and the time taken from when a patient becomes eligible for DMT therapy to receiving their chosen DMT treatment
Results:
Results for diagnosis, patients waited a median of 49 days between outpatient appointment and diagnosis. The range was between 0 and 381 days. This was compared to the 2003 audit where a median of 315 days with a range of 0 and 1764 days.
Patients eligible for DMTs started treatment in median time of 32 days. Regarding diagnosis, patients report that the wait from seeing their Neurologist with suspected diagnosis to a confirmed diagnosis. Regarding DMT treatment, Dr Gold’s 2010 abstract Evolving expectations around early management of multiple sclerosis states “current opinion on treatment encourages early intervention with well-tolerated disease-modifying treatments in order to optimize long-term clinical outcomes.” Therefore to show a median time of 32 days between patients eligible for DMTs and then starting treatment is very pleasing. In this audit there was an example of one patient with a gap of 243 days whilst the patient considered if they wanted treatment.
In comparison, the Novo study in Spain found the median overall time from initial medical consultation and the confirmation of the diagnosis by a specialised MS unit to be 5.7 months and the median time from symptom onset to first treatment was two years.
Conclusions:
Sunderland Royal patients wait a comparably short time for their diagnosis and treatment, and the service has moved forward considerably since the last audit in 2003, and is favourable compared to previous audits.