Marrie Ruth Ann, Donkers Sarah J, Jichici Draga, Hrebicek Olinka, Metz Luanne, Morrow Sarah A, Oh Jiwon, Pétrin Julie, Smyth Penelope, Devonshire Virginia
Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MA, Canada.
Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MA, Canada.
Front Neurol. 2022 May 20;13:904757. doi: 10.3389/fneur.2022.904757. eCollection 2022.
Little work has evaluated integrated models of care in multiple sclerosis (MS) and the composition of MS care teams across Canada is largely unknown. We aimed to gather information regarding existing models of MS care across Canada, and to assess the perceptions of health care providers (HCPs) regarding the models of care required to fully meet the needs of the person with MS.
We conducted an anonymous online survey targeting Canadian HCPs working in MS Clinics, and neurologists delivering MS care whether or not they were based in an MS Clinic. We queried the types of HCPs delivering care within formal MS Clinics, wait times for HCPs, the perceived importance of different types of HCPs for good quality care, assessments conducted, and whether clinic databases were used. We summarized survey responses using descriptive statistics.
Of the 716 HCPs to whom the survey was distributed, 100 (13.9%) people responded. Of the 100 respondents, 85 (85%) indicated that their clinical practice included people with MS and responded to specific questions about clinical care. The most common types of providers within MS Clinics with integrated models of care were neurologists and MS nurses. Of 23 responding MS Clinics, 10 (43.5%) indicated that there were not enough neurologists, and 16 (69.6%) indicated that there were not enough non-neurologist HCPs to provide adequate care. More than 50% of clinics reported wait times exceeding 3 months for physiatrists, physiotherapists, psychiatrists, psychologists, neuropsychologists and urologists; in some clinics wait times for these providers exceeded 1 year. Multiple disciplines were identified as important or very important for delivering good quality MS care. Over 90% of respondents thought it was important for neurologists, nurse practitioners, MS nurses and psychiatrists to be co-located within MS Clinics.
Canadian HCPs viewed the ideal MS service as being multidisciplinary in nature and ideally integrated. Efforts are needed to improve timely access to specialized MS care in Canada, and to evaluate how outcomes are influenced by access to care.
很少有研究评估过针对多发性硬化症（MS）的综合护理模式，而且加拿大各地MS护理团队的组成情况在很大程度上尚不清楚。我们旨在收集有关加拿大现有MS护理模式的信息，并评估医疗服务提供者（HCP）对能充分满足MS患者需求的护理模式的看法。
我们针对在MS诊所工作的加拿大HCP以及提供MS护理的神经科医生开展了一项匿名在线调查，无论他们是否就职于MS诊所。我们询问了在正式MS诊所提供护理的HCP类型、HCP的候诊时间、不同类型HCP对优质护理的重要性认知、所进行的评估以及是否使用诊所数据库。我们使用描述性统计方法总结了调查回复。
在716名被分发调查问卷的HCP中，100人（13.9%）做出了回应。在这100名受访者中，85人（85%）表示他们的临床工作涉及MS患者，并回答了有关临床护理的具体问题。采用综合护理模式的MS诊所中最常见的医疗服务提供者类型是神经科医生和MS护士。在做出回应的23家MS诊所中，10家（43.5%）表示神经科医生不足，16家（69.6%）表示非神经科HCP不足以提供充分护理。超过50%的诊所报告称，物理治疗师、物理治疗师、精神科医生、心理学家、神经心理学家和泌尿科医生的候诊时间超过3个月；在一些诊所，这些医疗服务提供者的候诊时间超过1年。多个学科被认为对提供优质的MS护理很重要或非常重要。超过90%的受访者认为神经科医生、执业护士、MS护士和精神科医生在MS诊所内同处一室很重要。
加拿大的HCP认为理想的MS服务应具有多学科性质且理想情况下应是整合型的。需要努力改善加拿大及时获得专业MS护理服务的情况，并评估获得护理服务的情况如何影响治疗结果。
