Article Text

Unmet needs in multiple sclerosis: the role of community services
  1. C MILANESE
  1. Instituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milano, Italy
  1. msgroup{at}istituto-besta.it

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Despite significant diagnostic and therapeutic advances in the past decades, multiple sclerosis still results, for most of the patients, in different degrees of disabilities that tend to progress over time, requiring various medical and non-medical interventions. Due to the variability in disease evolution, frequent assessments of patients' health status are necessary to provide the best management of their needs.

High quality medical care, which usually requires expensive diagnostic and therapeutic procedures and the patient's admissison to hospital, should be supplemented by reabilitation programmes and social interventions aimed at preventing disabilities and promoting the patient's independence in his social environment.

This global approach is mandatory to provide patients with the best care and it may result, at the same time, in an optimal use of resources, thus contributing to cost containment.

Valuable indicators, which health care planning should be based on, can be drawn from surveys on utilisation of medical and social services.

This issue is considered by Freeman and Thompson1 in this issue (pp 728–732) who investigate the current use of services and home modifications in a cohort of 150 patients with multiple sclerosis with a broad range of disease severity.

The study shows that a large proportion of patients with multiple sclerosis, even those severely disabled, fail to receive any community service, thus suggesting that many of the patients' needs are unmet by the current clinical practice.

Althought derived from a specific setting, the authors' conclusions fit with others' clinical experience and are likely to be true also in different sociocultural contexts.

It may be asked whether physicians are really aware of the actual needs of their patients, as it has been shown that patients' and doctors' perceptions of multiple sclerosis disability diverge considerably.2

More likely, in my opinion, the poor coordination between doctors and other health and social care professionals is responsible for the inadequate management of patients with multiple sclerosis. Interestingly a previous study found that, in severely disabled patients, unmet needs were consistently higher in those whose sole contact was with health professionals compared with those reassessed on a multidisciplinary basis by health and social services operators.3 It is expected that the improvement in utilisation of community services will result in cost containment by limiting the need of hospital admittance.

This is particulary important for severely disabled patients with multiple sclerosis who primarily account for the highest charges to the healthcare system.4

Most importantly healthcare givers and authorities should bear in mind that an effective coordination between professional operators and available services may contribute to improve the quality of life of patients with multiple sclerosis no less than the use of new expensive therapeutic agents does.

Careful cost effectiveness studies of alternative forms of treatment should be encouraged to provide clinical guidelines to help clinicians in their everyday practice.

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