Services for patients with multiple sclerosis

The development of β-interferon treatment for patients with multiple sclerosis has dramatically focused attention on and encouraged debate about the delivery of services to these patients.1Furthermore, patients with multiple sclerosis are now more interested in seeing their neurologists; the reverse is also true and all parties are interested in service provision. The purpose of this editorial is to inform the debate about services for this group of patients; it is biased towards considering disability services.

My aim is to enable purchasers, providers, and patients to discuss issues from a common, agreed perspective. I highlight some current problems, and then outline some principles underlying choices, present a framework of illness, discuss the processes of disease management, draw attention to the different phases of the illness caused by multiple sclerosis, and finish by outlining the aims and objectives of a service and discussing the organisation of services. I do not review, systematically or otherwise, all relevant evidence but cite evidence where possible. I argue that the problems faced by patients are complex and multifactorial, and that there will rarely be evidence to guide decisions on the specific problems faced by individual patients. Thus the conclusion is that the most effective and efficient service delivery will come from specialist services which focus on neurological disease and disability.