Toward a Shared-Care Model of Relapsing-Remitting Multiple Sclerosis: Role of the Primary Care Practitioner

AbstractThe objective of this study was to develop a shared-care model to enable primary-care physicians to participate more fully in meeting the complex, multidisciplinary healthcare needs of patients with multiple sclerosis (MS).Design:The design consisted of development of consensus recommendations and a shared-care algorithm.Participants:A working group of 11 Canadian neurologists involved in the management of patients with MS were included in this study.Main message:The clinical management of patients with multiple sclerosis is increasing in complexity as new disease-modifying therapies (DMTs) become available, and ongoing safety monitoring is required. A shared-care model that includes primary care physicians is needed. Primary care physicians can assist in the early detection of MS of individuals presenting with neurological symptoms. Additional key roles for family physicians are health promotion, symptom management, and safety and relapse monitoring of DMT-treated patients. General principles of health promotion include counseling MS patients on maintaining a healthy lifestyle; performing standard screening measures; and identifying and treating comorbidities. Of particular importance are depression and anxiety, which occur in >20% of MS patients. Standard work-ups and treatments are needed for common MS-related symptoms, such as fatigue, pain, bladder dysfunction, sexual dysfunction, spasticity, and sleep disorders. Ongoing safety monitoring is required for patients receiving specific DMTs. Multiple sclerosis medications are generally contraindicated during pregnancy, and patients should be counseled to practice effective contraception.Conclusions:Multiple sclerosis is a complex, disabling illness, which, similar to other chronic diseases, requires ongoing multidisciplinary care to meet the evolving needs of patients throughout the clinical course. Family physicians can play an invaluable role in maintaining general health, managing MS-related symptoms and comorbidities, monitoring for treatment-related adverse effects and MS relapses, and coordinating allied health services to ensure continuity of care to meet the complex and evolving needs of MS patients through the disease course.RÉSUMÉ:Élaborer un modèle de soins partagés dans les cas de sclérose en plaques récurrente-rémittente.Objectif:Élaborer un modèle de soins partagés afin de permettre aux médecins de première ligne de mieux répondre aux besoins complexes et multidisciplinaires de patients atteints de la sclérose en plaques (SP).Conception :Recommandations résultant d’un consensus et élaboration d’un algorithme en matière de soins partagés.Participants :Un groupe de travail formé de onze neurologues canadiens impliqués dans la prise en charge de patients atteints de la SP.Message-clé :La prise en charge clinique de patients atteints de la SP est de plus en plus complexe dans la mesure où des médicaments modificateurs de l’évolution de la maladie (MMSP) deviennent accessibles et où un suivi permanent en matière de sécurité est nécessaire. Soulignons aussi qu’un modèle de soins partagés incluant les médecins de première ligne est nécessaire. Ces professionnels peuvent permettre un dépistage plus rapide de la SP chez des individus présentant des symptômes neurologiques. Ils peuvent aussi jouer un rôle de premier plan en matière de promotion de la santé, de soulagement des symptômes et de suivi de patients traités avec des MMSP en ce qui a trait à leur sécurité et à de possibles rechutes. Parmi les principes généraux de promotion de la santé, on peut inclure les suivants : offrir aux patients atteints de la SP des conseils leur permettant de maintenir de saines habitudes de vie ; adopter des mesures de dépistage standards ; identifier et traiter les comorbidités. À cet égard, l’anxiété et la dépression sont d’une importance particulière et sont fréquemment signalées (> 20 %) chez les patients atteints de SP. Des démarches d’investigation et des traitements standards sont nécessaires dans le cas des symptômes courants reliés à la SP, par exemple de la fatigue, des douleurs, une dysfonction vésicale, des dysfonctions sexuelles, de la spasticité et des troubles du sommeil. On l’a dit, un suivi permanent s’impose dans le cas de patients bénéficiant d’un traitement spécifique avec des MMSP. Les médicaments associés à la SP sont généralement contre-indiqués durant la grossesse de sorte qu’on devrait conseiller aux patients d’adopter des méthodes de contraception efficaces.Conclusions :La SP est une maladie complexe et invalidante qui, à l’instar d’autres maladies chroniques, exige des soins multidisciplinaires continus afin de répondre, en lien avec un tableau clinique précis, aux besoins en constante évolution des patients. Les médecins de première ligne peuvent jouer un rôle irremplaçable à plusieurs égards : dans le maintien d’une bonne santé ; le suivi et le soulagement des symptômes et des comorbidités reliés à la SP ; le suivi des rechutes et des effets indésirables associés aux traitements. N’oublions pas non plus la coordination des services paramédicaux afin d’assurer, durant l’évolution de la SP, une continuité des soins répondant aux besoins complexes et en constante évolution des patients atteints de cette maladie.

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53 Implementation of a Developmental Outreach Clinic housed within a Family Health Team - preliminary findings in building a shared care model for children and youth with mental health and developmental disorders

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.052 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e22-e22

Author(s):

Elizabeth Young ◽

Rachel Goldfarb ◽

Laurie Green ◽

Kathleen Hollamby ◽

Karen Weyman ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Developmental Disorders ◽

Family Health ◽

Shared Care ◽

Care Model ◽

Roles And Responsibilities ◽

Shared Care Model ◽

Family Health Team

Abstract Background At our inner city hospital, we developed a shared care model between family health teams (FHTs), pediatricians and developmental pediatricians to care for children with mental health and developmental disorders. In phase one of our study, 84 FHT members participated in focus groups to inform the development of our clinic. Family physicians described their role as “referral agent”, “long term supporter” and “healthcare coordinator”. They expressed the desire to “learn” and “do more”, but noted barriers to providing care, including limited training, lack of service knowledge, limited communication, and cumbersome access to mental health and dual diagnosis services. Phase One was completed and accepted for publication. Phase Two describes the implementation of our clinic using a mixed methods approach and report preliminary findings. Objectives To evaluate the first two years of implementation of the developmental clinic housed within a family health team (FHT) an obtain feedback from members of the shared care model. Design/Methods Mixed methods were used including chart review of all patients referred to the clinic and semi structured interviews with primary care physicians, pediatricians and developmental pediatricians regarding their roles in managing children with developmental and mental health disorders, as well as use and impact of the developmental clinic. Results A total of 115 charts were reviewed between Feb 2016 and Jan 2018. Of all patients seen, 34% were female 64% male and 2% transgender. Ages ranged from 1-17 years. Eighty-one percent had an existing diagnosis and were referred for re-assessment while 43% received a new diagnosis: ASD (72%), ADHD (11%), GDD (11%), learning disorder (3%), Anxiety (1%), Other (1%). There was an 8% no show rate. Providers endorsed improved communication through use of a shared EMR for documentation and messaging, and improved service knowledge through availability of a pediatric service navigator who also used EMR to document service and funding applications. Longer term follow up, namely the roles and responsibilities of pediatrics vs. developmental pediatrics vs. primary care remained unclear. Conclusion Implementation of the shared care model for this population with primary care is feasible, and does address some stated barriers to care, including improved communication, increased service knowledge, and provision of reassessments. Further areas to develop include clarifying the roles and responsibilities of the different healthcare providers of children with mental health and developmental disorders, and determining what is needed for long-term follow up and transitional care.

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Health care utilization among long-term cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.22 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 22-22 ◽

Cited By ~ 2

Author(s):

Emily Jo Rajotte ◽

Leslie Heron ◽

Karen Leslie Syrjala ◽

Kevin Scott Baker

Keyword(s):

Primary Care ◽

Health Care ◽

General Population ◽

Cancer Survivors ◽

Care Physician ◽

Shared Care ◽

Care Utilization ◽

Care Model ◽

Clinic Appointment ◽

Shared Care Model

22 Background: Survivors of adult cancer face lifetime health risks that are dependent on their cancer, cancer treatment exposures, comorbid health conditions, and lifestyle behaviors. A shared care model, including planned and formal transition of the cancer survivor from the oncologist to the primary care physician needs to be established to ensure appropriate care. Methods: As a LIVESTRONG Survivorship Center of Excellence Network member, the Survivorship Program at the Fred Hutchinson Cancer Research Center has established an outpatient clinic at the Seattle Cancer Care Alliance to meet the clinical needs of cancer survivors. Before their survivorship-focused clinic appointment, adult cancer survivors are asked to complete a comprehensive survey that includes questions on health care utilization. Results: Between August 2013 to December 2014, 142 clinic patients completed the survey. They were 70.4% female, mean age 48 years (SD 16.3, range 22-83) and 21.1% breast cancer, 30.2% leukemia/lymphoma, and 17.6% reproductive cancer survivors. Patients were a mean of 7.8 years (SD 9.5, range 0-43) from their cancer diagnosis at the time of clinic appointment. 70.4% reported receiving oncology care and 87.3% primary care within the 12 months before their survivorship visit. Forty percent reported more than 12 clinic visits in the past year in which they saw a physician, nurse practitioner or physician assistant compared with 6.5 clinic visits in the general population based on CDC, National Health Care Survey reference data. 41.5% had one or more visits to a hospital emergency or urgent care facility within the last year, compared with 39.4% in the CDC NHCS survey. Conclusions: Cancer survivors seen in a Survivorship Clinic utilize healthcare at a much higher rate than the general population. A shared-care model for cancer survivors, including a delineation of roles and specific points of communication, between the oncologist and the primary care physician may help address issues surrounding over-utilization. A cancer treatment summary and a survivorship care plan may be valuable tools to facilitate this shared care approach.

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P2-275: DEMENTIA CARE INTEGRATION BETWEEN PRIMARY CARE PROVIDER AND TERTIARY HOSPITALIST: AN INNOVATIVE DEMENTIA SHARED CARE MODEL

Alzheimer s & Dementia ◽

10.1016/j.jalz.2014.05.953 ◽

2014 ◽

Vol 10 ◽

pp. P577-P577

Author(s):

Mei Sian Chong ◽

Colin Tan ◽

Cindy Yeo ◽

Kang Yih Low ◽

Philomena Anthony ◽

...

Keyword(s):

Primary Care ◽

Care Provider ◽

Primary Care Provider ◽

Dementia Care ◽

Shared Care ◽

Care Model ◽

Care Integration ◽

Shared Care Model

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Promoting the Shared-Care Model for Adolescent and Young Adults With Cancer: Optimizing Referrals and Care Coordination With Primary Care Providers

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2017.0005 ◽

2016 ◽

Vol 15 (1) ◽

pp. 38-44 ◽

Cited By ~ 3

Author(s):

Karen E. Kinahan ◽

Sheetal Kircher ◽

Jessica Altman ◽

Alfred Rademaker ◽

John M. Salsman ◽

...

Keyword(s):

Primary Care ◽

Young Adults ◽

Care Coordination ◽

Primary Care Providers ◽

Shared Care ◽

Care Providers ◽

Care Model ◽

Shared Care Model ◽

Adolescent And Young Adults

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The Role of the Primary-Care Physician in Treating Relapses in Multiple Sclerosis Patients

International Journal of MS Care ◽

10.7224/1537-2073-11.3.122 ◽

2009 ◽

Vol 11 (3) ◽

pp. 122-126 ◽

Cited By ~ 1

Author(s):

Sarah A. Morrow ◽

Marcelo Kremenchutzky

Keyword(s):

Multiple Sclerosis ◽

Primary Care ◽

Primary Care Physicians ◽

Tertiary Care ◽

Care Physician ◽

Diagnosis And Treatment ◽

High Prevalence ◽

Tertiary Care Centers ◽

Multiple Sclerosis Patients

Multiple sclerosis (MS) is a common disabling neurologic disease with an overall prevalence in Canada of 240 in 100,000. Multiple sclerosis clinics are located at tertiary-care centers that may be difficult for a patient to access during an acute relapse. Many relapses are evaluated by primary-care physicians in private clinics or emergency departments, but these physicians' familiarity with MS is not known. Therefore, a survey was undertaken to determine the knowledge and experience of primary-care physicians regarding the diagnosis and treatment of MS relapses. A total of 1282 licensed primary-care physicians in the catchment area of the London (Ontario, Canada) Multiple Sclerosis Clinic were identified and mailed a two-page anonymous survey. A total of 237 (18.5%) responses were obtained, but only 216 (16.8%) of these respondents were still in active practice. Of these 216 physicians, only 9% reported having no MS patients in their practice, while 70% had one to five patients, 16.7% had six to ten, and 1.9% had more than ten (3.7% did not respond to this question). Corticosteroids were recognized as an MS treatment by 49.5% of the respondents, but only 43.1% identified them as a treatment for acute relapses. In addition, 31% did not know how to diagnose a relapse, and only 37% identified new signs or symptoms of neurologic dysfunction as indicating a potential relapse. Despite the high prevalence of MS in Canada, primary-care physicians require more education and support from specialists in MS care regarding the diagnosis and treatment of MS relapses.

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Shared Care Model in a Federally Qualified Health Care Center for the Homeless

The Journal of the American Board of Family Medicine ◽

10.3122/jabfm.2012.02.110327 ◽

2012 ◽

Vol 25 (2) ◽

pp. 253-254 ◽

Cited By ~ 1

Author(s):

L. Price-Stevens ◽

J.-V. R. Goode

Keyword(s):

Health Care ◽

Care Center ◽

Shared Care ◽

Care Model ◽

Health Care Center ◽

Shared Care Model ◽

Qualified Health Care

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The aging male population and medical care for benign prostatic hyperplasia in Canada

Canadian Urological Association Journal ◽

10.5489/cuaj.808 ◽

2013 ◽

Vol 4 (2) ◽

pp. 123

Author(s):

Nigel S. B. Rawson ◽

Fred Saad

Keyword(s):

Primary Care ◽

Benign Prostatic Hyperplasia ◽

Nous Avons ◽

Medical Care ◽

Primary Care Physicians ◽

Prostatic Hyperplasia ◽

Population Projections ◽

Prise En Charge ◽

Male Population ◽

Statistics Canada

Background: The male Canadian population is aging and more menwill be seeking medical care for benign prostatic hyperplasia (BPH).We examined the projected increase in older Canadian males between2005 and 2018 to evaluate urologic health-care needs.Methods: We used Statistics Canada population projections toderive predictions of the male population aged 50 or more from2005 to 2018 and results from the Olmsted County Study of UrinarySymptoms to estimate numbers of males aged ≥50 with moderateto severe lower urinary tract symptoms (msLUTS) in the sameperiod. Data from the Canadian Institute for Health Informationwere used to estimate the number of urologists in 2018.Results: The number of Canadian men aged ≥50 is projected torise between 2005 and 2018 by 39.5% and the number withmsLUTS by 41.3%. However, the number of practicing urologistsin Canada in 2018 is likely to be similar to the 584 practicing in2007. An increase in the number of urologists proportional to theincrease in men aged ≥50 with msLUTS would require 799 urologistsin 2018.Interpretation: Little opportunity exists to expand the number of traineesin urology. Other alternatives must be sought to deal with increasednumbers of older men with msLUTS. Initial management of BPHhas moved towards being a responsibility of primary care physicians,but they appear to view BPH as a quality-of-life issue. It iscrucial that urologists work closely with primary care physicians toensure that the management of LUTS progression is optimized.Introduction : La population masculine canadienne vieillit, et deplus en plus d’hommes consulteront un médecin en raison d’unehyperplasie bénigne de la prostate (HBP). Nous avons étudié levieillissement prévu de cette population entre 2005 et 2018 afind’évaluer les besoins en soins urologiques.Méthodologie : À l’aide des projections démographiques de StatistiqueCanada, nous avons formulé des prévisions quant à la populationmasculine de 50 ans et plus entre 2005 et 2018; les résultatsde l’étude du comté d’Olmsted sur les symptômes urinaires nousont permis d’évaluer le nombre d’hommes de 50 ans et plus quidevraient présenter des symptômes modérés ou graves touchantles voies urinaires inférieures pendant la même période. Desdonnées de l’Institut canadien d’information sur la santé ont permisd’évaluer le nombre d’urologues en 2018.Résultats : Le nombre de Canadiens de 50 ans et plus devrait augmenterde 39,5 % entre 2005 et 2018, et le nombre d’hommesprésentant des symptômes modérés ou graves touchant les voiesurinaires inférieures, de 41,3 %. En revanche, le nombre d’urologuespratiquant en 2018 au Canada devrait être semblable aunombre établi en 2007 (soit 584). Pour que la hausse du nombred’urologues soit proportionnelle à la hausse du nombre d’hommesde 50 ans et plus qui présenteront des symptômes modérés ougraves touchant les voies urinaires inférieures, il faudrait que cenombre atteigne 799 en 2018.Conclusion : Il est peu probable que le nombre de médecins sespécialisant en urologie augmente. D’autres solutions doiventdonc être mises de l’avant afin de faire face au nombre croissantd’hommes âgés au prise avec des symptômes modérés ou gravestouchant les voies urinaires inférieures. La prise en charge initialede l’HBP incombe maintenant aux médecins de premiersrecours, mais ces derniers semblent considérer l’HBP comme unproblème de qualité de vie. Il est primordial que les urologuescollaborent étroitement avec les médecins de soins primaires pourassurer une prise en charge optimale des symptômes touchantles voies urinaires inférieures.

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