ABSTRACT
Objective: To survey the impact of the Covid-19 pandemic, (April 2020-April 2021), on access to specialist care for people with multiple sclerosis (PwMS) within the Belfast Health and Social Care (HSC) Trust. Background: The challenges of healthcare service provision have been significantly heightened during the covid-19 pandemic. For PwMS, access to healthcare is of permanent importance, and has been greatly challenged during this timeframe. Design/Methods: In March/April 2021, we posted an anonymised survey to 2342 pwMS receiving care in the Belfast HSC Trust. Data was analysed on returns received by mid-May 2021. Results: In total, 1072 (45.8%) pwMS responded, mean age 53 years, female: male 2.6:1. Of these, 895 (84.2%) were ambulant with or without aid. Wheelchair use was reported in 14.6%. Relapsing remitting MS, Secondary progressive MS and primary progressive MS patients made up 67.7%, 15.5% and 5.9% of indicative responses, respectively. In all, 179 (17%) experienced a confirmed relapse during the pandemic, with 37.4% of these receiving steroids. Perceived delays in appointments were most frequent in: clinic review (17.9%), imaging (13.3%), physiotherapy (11.6%). Over half (52.8%) reported no delays. In total, 64.5% were taking disease-modifying therapy (DMT), most frequently: dimethyl fumarate (34.9%), betainterferon (18.0%), teriflunomide (12.4%). With new DMT commencement during the pandemic, 11.5% experienced delay. In those already DMT-established, 6.6% had a delay with infusion, 4.3% in switching DMT, whilst 89% experienced no delay. Only 2.0% of pwMS on DMT had their treatment stopped directly due to Covid-19. During the pandemic, 13.8% pwMS reported difficulty contacting the MS team, while 40.7% reported physical deconditioning. A majority (88%) had received a covid-19 vaccine dose. Conclusions: Whilst most patients experienced normal standard care, Covid-19 has impacted service provision for some pwMS, with delays reported across a multi-faceted service. The downstream effects of this may be seen moving beyond the pandemic.
ABSTRACT
Background Within our service, all scheduled face-to-face neurology clinics were cancelled from March 2020 due to Covid-19. Telephone reviews were initiated to provide continuity of MS care. Objective To assess patient satisfaction with MS telephone clinics during the pandemic and opinion regarding potential future use. Design/Methods Anonymised questionnaires were posted to 635 patients receiving MS specialist medical telephone review, March to July 2020. Results 279 (44%) patient questionnaires were returned, mean age 49 years, 72% female, 87% having an EDSS <7.0. On a rating scale, (0'10, 10 = completely satisfied), 95% of patients reported a satisfaction score ≥7. For 99% of patients, clinical interaction was caring/sensitive by telephone. Satisfaction was high with: call duration (96%), opportunity to ask questions (99%) and understanding advice given (98%). During the pandemic, 87% of patients preferred the virtual appointment. Of all patients, 45% expressed preference for telephone review moving forward, rising to 55% among both wheelchair-using patients and those living >50 miles from clinic. Many felt that video call would further improve virtual review (54%). Conclusions During the COVID-19 pandemic, satisfaction is high with MS review by telephone. A signifi-cant body of patient opinion supports telephone clinics beyond Covid-19. This is influenced by EDSS and distance from clinic.
ABSTRACT
Background Providing care to Multiple Sclerosis (MS) patients has been a challenge during the Covid-19 pandemic. Locally, surge plans necessitated an abrupt change of facility for infusional services, now supervised by MS nurses, from an acute site (Royal Victoria Hospital, RVH) to a non-acute site at Musgrave Park Hospital (MPH). Objective To assess patient satisfaction with MS infusional therapies at a new, non-acute location and supervision of the service by MS Specialist nurses in comparison with previous arrangements. Methods Anonymous patient surveys were developed and collected in order to assess patient demo-graphics and levels of satisfaction across various service domains. Results All 120 offered surveys were returned. Overall, 97% recorded a satisfaction score of ≥8/10 (0'10, 10 = extremely satisfied). Key areas of improvement: difficulty parking (0.8% vs 50% in RVH), difficulty of unit access (0.8% vs 38% previously), appointment punctuality (95% on time vs 35% previously), and comfort (83% vs 55% previously). Thematic analysis revealed several key improvement areas: access to MS nursing knowledge, cannulation, and punctuality. Conclusion The urgently relocated service, with better access and specialist nursing input, was associ-ated with substantial improvements in patient experience. Despite current unprecedented pressures on healthcare delivery, unique opportunities remain for service improvement.
ABSTRACT
Objective: To assess patient satisfaction with virtual telephone clinics during the pandemic, influencing factors on this, and future utility. Background: Covid-19 has had a significant impact on all health services. With in our service, all face-to-face neurology clinics were cancelled from March 20th 2020, due to increasing clinical demands, staff redeployment and exposure risk to patients. Telephone reviews were initiated as an alternative and the Multiple sclerosis (MS) team embraced this method to provide continuity of care. Design/Methods: We developed a postal questionnaire for patients receiving telephone reviews from an MS consultant or clinical fellow, March to July 2020. Ultimately, 635 anonymised questionnaires were posted to patients. Data analysis deployed both quantitative and qualitative methods. Results: To date, 254 (40%) patient questionnaires have been returned, mean age 50 years, 72% female, and 86% having an EDSS< 7.0. Using a numerical rating scale (0-10, 10 = completely satisfied), 96% of patients reported an overall satisfaction score of ≥7. For 99% of patients, they found interaction to be sensitive and caring over telephone. Most patients were content with call duration (96%) and reported ample opportunity to ask questions (99%). During the pandemic, 89% of patients preferred the telephone call to a face-to-face appointment. For 47% of patients, there was clear preference for telephone review moving forward, rising to 55% among both wheelchair-using patients and those living more than fifty miles from clinic. 54% of patients felt that video call would further improve virtual clinical review. Conclusions: During the COVID-19 pandemic, satisfaction is high with the telephone approach to MS clinical consultation. Although mixed, and influenced by level of disability and distance from the clinic, a significant body of patient opinion supports telephone calls remaining part of the clinic experience in the post-COVID era. This may lead to more efficient resource utilisation and minimise inconvenience and stress for patients.
ABSTRACT
Objective: To assess patient satisfaction with delivery of MS infusional therapies at the new location, supervised by specialist MS nurses, compared to the previous delivery of treatments at the Regional Centre, which had limited input from the MS nursing team but was delivered by infusional nurses. Background: Providing safe and effective care to Multiple Sclerosis (MS) patients has been a challenge during the Covid-19 pandemic. Across Northern Ireland, surge plans necessitated an abrupt change of facility for MS infusional services from the Royal Victoria Hospital (RVH) to a non-acute site at Musgrave Park Hospital (MPH). The MS specialist nursing team moved to deliver the service in an unfamiliar setting. Design/Methods: A questionnaire was developed to survey patient experience of the revamped service, which patients were invited to complete upon attendance for infusion. Patient consent was implied by completion of the questionnaire. Data collected included demographics and levels of service satisfaction across various headings. Results: In total, 120 responses were received (100% return) indicating a strong preference for the new service arrangement in MPH. Overall, 97% recorded a satisfaction score of ≥8/10 (0-10, 10 = extremely satisfied). Key areas of improvement at MPH were: Difficulty parking (0.8% vs 50% in RVH), difficult access to the unit (0.8% vs 38% previously), appointment punctuality (95% on time vs 35% previously), and comfort (83% vs 55% previously). Thematic analysis revealed positive free-text feedback centred on: Improved access to MS nursing knowledge, improved cannulation skills, and time-keeping. The most frequent (46%) suggestion for improvement was more comfortable seating. Conclusions: This study demonstrates very strong satisfaction with the relocated infusional service. Better service access and specialist nursing input were associated with clear improvements in patient experience. This study illustrates the unique opportunity for service improvement during a time of unprecedented pressure on healthcare systems.