Samantha ColhounCNS – MS

Queen Elizabeth Hospital - Birmingham

Cover large area of Birmingham for 1st line DMT’s

Provide regional Tysabri, Lemtrada and Fingolimod services

Initially developed DMT discussion groups due to large waiting list

Capacity issues with clinics

Team philosophy – education is the key to adherence

6 - 7 groups held each month Separate groups for 1st line DMT’s,

Lemtrada and Fingolimod 4 – 6 patients attend each group Discussion group lasts up to 2 hours (inc

screening) Some individuals will not be suitable and

seen in clinic ie language barrier, cognition, anxiety

VARK LEARNING STYLE

Patients are invited to attend with someone Written information sent with invitation

letter◦ DMT booklet (MS Trust) for 1st line or◦ Fingolimod / Lemtrada patient pack◦ Directed to MS Decisions

Screening booklet completed:◦ Blood tests and other investigations◦ Previous DMT’s◦ Allergies◦ Current medications◦ Previous medications (ie immunosuppressant's,

caridac)

Screening booklet completed:◦ Supplementary therapies◦ Any other conditions (current or previous) ie

cancers◦ Contraception◦ Baseline obs (BP, pulse and temp)

A power point presentation of the therapies available

After each drug discussed – practical demonstration of devices (injectables)

Patients are encouraged to handle the devices

Overview of the therapies inc:◦ Mode of action◦ Side effects◦ Monitoring◦ Initiation◦ Delivery / training / administration of therapy◦ Other medications◦ Relapses and steroids◦ Pregnancy◦ Travel◦ Supplementary therapies◦ Stopping criteria

Patient (and relative/friend) have one to one with MS nurse

If patient undecided they will either:◦ Ring when made decision◦ Attend further clinic app to discuss

Check list is signed by both patient and MS nurse, copy given to patient

Outlines points covered in the presentation To ensure their understanding of the

process including adherence / stopping criteria

Patients are encouraged to think about:◦ Lifestyle◦ Work ◦ Children◦ Religion◦ Diet limitations: ie vegetarian, PEG◦ Managing side effects◦ Adherence

Audit every 12 – 24 months Results have always been positive

◦ Duration of session◦ Information provided

Patient feedback

Small enough group to ask

questions

Straight forward and understandable

Relaxed atmosphere

People asked useful questions that I had not thought of