Advanced Practice Clinicians' Assessment of Care Strategies for Multiple Sclerosis Care

Background: Establishing best practices for multiple sclerosis (MS) care is a challenging endeavor for Advanced Practice Clinicians (APCs). Care practice algorithms are disseminated by various MS care organizations but tend to focus on pharmacological treatment selection. A need exists for a holistic approach to care management with a focus on both patients and caregivers.

Objectives: Identify and assess care strategies to encourage a holistic approach to MS care by APCs.

Methods: An MS Care Strategies Steering Committee comprised of APCs was formed in early 2015. Over a 6 month period, committee members participated in in-depth interviews and 3 planning meetings to design a 49-question survey. The survey was sent to International Organization of MS Nurses (IOMSN) members in an online survey fielded between June 29 and August 3, 2015. Respondents were asked to identify unmet needs for MS patients and to organize 79 care inputs into 3 broad categories of patient care: Disease Course (eg, form of MS), Patient Profile (eg, medical history), and Other Care Considerations (eg, family support). Respondents were also asked to assess 3 visual models designed by the steering committee using 7 attributes to determine clinical relevance. Descriptive analyses were used to describe the survey results.

Results: Thirty APCs completed the online survey. The majority of respondents identified themselves as MS Certified or Registered Nurses (90%). Based on a weighted ranking, APC respondents endorsed considering Patient Profile (140), followed by Disease Course (90) and Other Care Considerations (40) when managing patients. Greater than 50% of respondents were in agreement with the organization of 67 (85%) care inputs within each patient care category. A visual patient care model centered on the patient and family and emphasized fluidity and interconnectedness of the multidisciplinary MS care team was rated as moderately to extremely positive by 46% of respondents.

Conclusions: While the sample size was small, there is substantial agreement on what comprises best practices for patient care from this perspective. APCs surveyed agree that caring for MS patients is multifaceted, and a visual aid that helps patients and APCs comprehend this complexity is important for patient care. Future work should refine and substantiate these initial findings and could also provide a model to empower the MS patient to ensure all their needs are being met.