Multidisciplinary Approach to Symptom Management in MS

Transcription

1 Multidisciplinary Approach to Symptom Management in MS Emily Cade, M.S., CCM, CRC, CLCP Program Manager Andrew C. Carlos MS Institute Shepherd Center Atlanta, Georgia A Complex Disease A Comprehensive Approach Slow my disease course! Symptom Management Needed! MS Treat this relapse! Improve function, safety, & emotional wellbeing 1

2 One Size Does NOT Fit All MS is a disease where one size does not fit all. Healthcare professionals need to consider adopting an integrated model that encompasses therapeutic, rehabilitative, and palliative care. Weight must be given to medical and psychosocial models of disability Comprehensive Care in MS CMSC White Paper Why Comprehensive Care? It has been found that a multi dimensional team approach is the most effective and efficient way of treating people with MS (Harris et al, 2003; Vickery et al 2000; Forbes, 2007) An interdisciplinary approach to MS care facilitates coordination of services & continuity of care, while hopefully avoiding duplication and fragmentation of services for the patient and care partner. Comprehensive care embraces a philosophy of empowerment for the patient with MS. The patient becomes an active part OF the team. Comprehensive Care in MS CMSC White Paper 2

3 The Objectives of Comprehensive MS Care We Will Discuss Today Diagnose and/or confirm the diagnosis of MS. Treat both acute episodes and modify the long term disease course. Provide medical treatment and management of MS symptoms. Promote mobility for persons with physical impairments. Minimize secondary and tertiary symptoms. Help patients to maximize functional abilities, independence, safety measures, and productivity. Assist patients and their families to cope with the psychological implications of MS. Encourage patients and their families to become part of the rehabilitation process. Provide education and information to patients, their families, healthcare professionals, and the community. Network with other community resources to obtain appropriate services. Design, conduct, and participate in research studies in multiple sclerosis. Comprehensive Care in MS CMSC White Paper The : Meeting those Objectives Medical NP & PA Support Clinical Ancillary 3

4 Diagnose and/or confirm the diagnosis of MS. Ancillary Referring MD (PCP) Important to receive as much information from referral source as possible to make best assessment. Ancillary services utilized during this stage might include MRI, lab, etc. Treat acute episodes and modify the long term disease course. Personal Support Focus on both treating the issues at hand while considering long term treatment plan. Engagement of patient and personal support important at this stage to increase understanding of choices. 4

5 Provide medical treatment and management of MS symptoms. Rehab Medical May need to engage other medical services including urology, physiatry, etc. to assist with logistical barriers to treatments? Rehabilitation may include PT, OT, ST Education is key! NP, PA, Promote mobility for persons with physical impairments. Assistive Technology, NP, or PA may refer to rehab program at this time (outpatient vs. home health) Assistive Technology consults occur at this stage for wheelchair seating evaluations. may need to assist with funding for mobility devices 5

6 Minimize secondary and tertiary symptoms. Medical There are symptoms that are primary symptoms of MS, meaning they are due to the disease process itself. Secondary symptoms are complications of primary symptoms. Secondary symptoms have the potential to be more troublesome or severe than the symptoms from which they stem. May need to engage other medical services including urology, physiatry, etc. Help patients to maximize functional abilities, independence, safety measures, and productivity. Vocational Rehab Assistive Technology may perform assessments and make referrals to agencies as appropriate Rehabilitation may include PT, OT, ST If patient is working or interested in vocational pursuits, referral to Voc Rehab may be helpful at this stage. Assistive Tech may assist with home mods or driver s evaluations / mods 6

7 Assist patients and their families to cope with the psychological implications of MS. Psychiatry s Support System Speech Therapy / Neuropsych From testing to counseling, psychology and neuropsych services are very important in reaching this goal. Speech Therapy is able to serve as a resource for issues related to cognition. Referral to psychiatry may be warranted for patients requiring medication management. Encourage patients and their families to become part of the rehabilitation process. s Support System Important to have the patient s support system (spouse, family member, partner, etc.) at the table for discussions surrounding importance of rehabilitation. Train patients and support systems on home exercise programs, use of equipment, etc. Nurses and therapist can provide vital education during this stage. 7

8 Provide education and information to patients, their families, healthcare professionals, and the community. Support Medical Healthcare Professionals Our Community NP & PA It is our responsibility to education not only the patients & families we serve, but also the healthcare professionals and our communities about Multiple Sclerosis. Clinical / Ancillary Home Health National MS Society Network with other community resources to obtain appropriate services. Multiple Sclerosis Association of America MS Foundation PCP Agency on Aging Area Hospital Systems There are many community resources available to assist patients with MS. Contact your local National MS Society chapter, the MSAA, and MSF. Many times home health companies have social workers on staff. If you make a home health referral for PT, OT, ST, nursing, or IV treatment consider adding a request for social work consult. If your patient is uninsured, you may want to contact local hospital systems to see if they have charity programs for patients which may cover other medical specialties (urology, hematology, etc.) 8

9 Design, conduct, and participate in research studies in multiple sclerosis. Assistive Technology PA & NP Clinical Drug Trials Although researchers have not been able to identify with certainty the cause of MS, progress is being made. Healthcare Policy & Changing Landscape Studies Neuroimaging Neuropsych is critical for developing new treatments to control disease progression and decrease effects of symptoms patients face on a daily basis. The interdisciplinary team is key in making a comprehensive care plan work for the patient. 9

10 Steps to Keeping Your Out of Trouble: 1. You must start with a strong foundation Avoid temptations to plunge in without setting goals, developing objectives, creating skill profile. Without this step, a team may be prone to ongoing confusion and backtracking. 2. Provide training s need an understanding of team concept, team development and empowerment, skills in facilitation, effective team behaviors. 3. Create and use your team s Norms Set your own rules of conduct. Active use of norms is the an important tool in managing behaviors 4. Identify team problems Instead of waiting for problems to become huge, its best to identify blocks to high performance when issues first arise. 5. Use peer feedback Have a system where members can regularly give feedback to others 6. Monitor team and meeting effectiveness Are you getting what you need out of your meetings? Are you meeting to discuss meetings? 7. Implement leader feedback Avoid power struggles by holding leader member relationship check ups. Keeping Your Out of Trouble Bens, I In Closing.. Remember that no MS team will have it all. Reach outside of your walls to compliment what your team has to offer. The coordination and time spent are worth the rewards your patients will experience as a result. 10

11 Resources Multiple Sclerosis Foundation msfocus.org Comprehensive Care in Multiple Sclerosis (CMSC White Paper 2010) Keeping Your Out of Trouble; Bens, I National Multiple Sclerosis Society : Comprehensive Care 11