#MSCovid19 – Running a remote MS service

Summary

Consultant neurologists Dr Niall MacDougall and Dr Brendan McLean who both practice in rural and remote settings, discuss the practicalities of remote-managing patients alongside Western Isles-based specialist nurse Rachel Morrison and neuro-pharmacist Joela Mathews.

All have varied experience with remote-managing their patients and discuss both their historic learning and their current practice managing patients during the COVID-19 pandemic.

Practical ideas on video-clinics, telemedicine tools and more abound in this useful webinar.

Rachel:

‘Coronavirus hasn’t changed our service’.

• Aiming to provide an equitable service across 9 islands, and unable to use Skype because it wasn’t NHS-secure, Rachel worked with her tech-team to develop a way to use video calls with NearMe technology.
• The service has reduced travel costs for patients, and is more convenient for them, as well as enabling her to provide clinics, expertise and support to a far greater number of patients each day than she would if running physical clinics and appointment.
• Rachel advises offering advice sheets to patients on how to use the tech and how to get the most out of their appointments.
• Rachel is working at home for her health and is still conducting a full service with very little change at all experienced by either herself or her patients.

Brendan:

‘I think it’s taken a lot of the stress out of the service’ – for patients and staff alike.

• Brendan notes that the local nurses find it easier to set up telephone clinics with a fixed clinic list, running 4 or 5 clinics per week.
• Any assessments that don’t need physical touch, such as looking at gait, walking distance, and such can all be done remotely.
• Brendan feels remote clinics have taken the stress out appointments for his patients, when contrasted with ‘face to face’ traditional appointments where there are just a few minutes for them to try and get all their information out at once.
• Brendan noted that both the neurologists and nurses can often respond far more quickly to people using phones and digital health solutions.
• The specialist nurses run an active email advice service with a 24 hour response rate.
• A survey carried out a few years ago found that remote clinics were getting well received by patients.
• There’s a great deal that can be done by talking to people and for the few aspects that need someone else to be with the patient, we can ask for a family member to support that.

Joela:

‘A lot of this is just common sense’ as we change how we get patients their medication during the pandemic

• Some home care companies decided to take no new patients. There will be a lead in each Trust who is managing this and new homecare companies are taking on these new patients, on a Trust by Trust basis.
• Remote-medication support:
• Courier use – we only have one courier which spans multiple conditions and if they travel far afield because patients have gone back to hometowns rather than self-isolate in London, this means no-one in London gets their medications on that day. Because of this we are using special delivery services with Royal Mail far more.
• Patient’s delivery addresses – many patients have their work addresses listed as their place of delivery for medications because that is usually where they are during the day; please remember to ask patients to update their details with their pharmacies as to where they are currently.
• Like everywhere, we in pharmacies and medications are also being impacted by sickness, so please bear that in mind in terms of capacity.
• Use common sense in monitoring – if someone has been stable on a given medication for some time, you can reduce your monitoring of them.
• If we reduce everyone’s treatment, we will end up with a different problem later on with people under-treated.
• FP10s for remote prescriptions – Trust rules mean that you have to have a person on-site to prescribe for you, and any neurologist on site can access FP10s to remotely prescribe. Try not to rely on primary care, or on a named individual as they may also become sick.

Questions answered included:

• How current infusions being carried out with ideas discussed around home infusions in the future
• How to manage relapse remotely
• The levels of scanning and monitoring of patients at present
• Whether anyone is using self-assessment batteries and questionnaires around quality of life and everyday living
• DMT initiation and use
• Remote management and adhering to compliance and governance guidance

Useful links:

• Shifting to self-monitoring – healthy lifestyles in MS
• AIMS assessment tool which Rachel uses annually with patients and could be shared with patients ahead of a video call as part of a self-assessment battery if required
• Webinars on the use of disease-modifying therapies during the pandemic