Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada.
Undergraduate Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Can J Neurol Sci. 2019 Jul;46(4):389-393. doi: 10.1017/cjn.2019.19. Epub 2019 May 21.
Advances in multiple sclerosis (MS) disease modifying therapy (DMT) have increased laboratory monitoring requirements. Our goal was to survey existing practices and perceptions of risk in laboratory monitoring throughout Canada and assess whether opportunities to improve patient care and safety exist.
A web-based survey assessing prescriber demographics, current infrastructure, and concerns for lab monitoring was sent to the Canadian Network of MS Clinics (CNMSC) listserv, inviting MS clinicians across the country to participate.
Respondents included 32/65 CNMSC-affiliated neurologists (49%), 6 registered nurses (RN), 2 nurse practitioners (NP), and 2 non-neurologist physicians from 8/10 provinces. For some questions, analysis was limited to 34 DMT-prescribing clinicians only. Despite broad implementation of electronic medical records (25/34, 74%), many prescribers (15/34, 44%) still receive laboratory results in paper form. In terms of lab monitoring infrastructure, we noted regional variability in the employment of nursing to monitor patient compliance with required laboratory monitoring. There is also a gap in laboratory surveillance, as less than 5% of respondents reported regularly reviewing results on weekends. Providers' length of practice and volume of MS patients were not associated with different perception of DMT laboratory monitoring risk.
This nation-wide survey showed variability in infrastructure used in laboratory monitoring and regional variation in nursing involvement. Providers' level of concern for laboratory monitoring for DMTs did not vary by years of experience or volume of MS patients followed, suggesting that improved systems, rather than education, could ameliorate perceptions of risk.
多发性硬化症（MS）疾病修正疗法（DMT）的进步增加了实验室监测的要求。我们的目标是调查加拿大各地实验室监测的现有实践和风险认知，并评估是否有机会改善患者的护理和安全性。
一项基于网络的调查评估了处方医生的人口统计学、当前的基础设施和对实验室监测的担忧，并通过加拿大多发性硬化症临床网络（CNMSC）的邮件列表发送给全国各地的 MS 临床医生，邀请他们参与。
共有 32/65 名与 CNMSC 有关的神经科医生（49%）、6 名注册护士（RN）、2 名护士从业者（NP）和 2 名非神经科医生参加了调查，他们来自加拿大 10 个省份中的 8 个。对于某些问题，分析仅限于 34 名 DMT 处方医生。尽管广泛实施了电子病历（25/34，74%），但许多医生（15/34，44%）仍以纸质形式接收实验室结果。在实验室监测基础设施方面，我们注意到在雇用护士监测患者遵守规定的实验室监测方面存在地区差异。实验室监测也存在差距，因为不到 5%的受访者报告说他们经常在周末查看结果。提供者的从业年限和 MS 患者的数量与对 DMT 实验室监测风险的不同认知没有关系。
这项全国性调查显示，实验室监测中使用的基础设施存在差异，护理参与度存在地区差异。提供者对 DMT 实验室监测的关注程度与从业年限或所治疗的 MS 患者数量无关，这表明改进系统而不是教育可以改善对风险的认知。
