Long-Term Treatment Optimization in Individuals With MS
The introduction of disease-modifying therapies (DMTs) for multiple sclerosis (MS) over the last 7 years has had a significant effect on the management of those living with this disease. Initially, the focus of improving treatment outcomes was on ensuring adherence to therapy by managing drug-related adverse events. However, treatment adherence is only one facet of ensuring optimal health outcomes for patients using DMTs. Therefore, a group of 80 nurses from Canada and the United States (The North American MS Nurses' Treatment Optimization Group) developed an evidence-based nursing approach to address the various factors involved in obtaining optimal patient outcomes. The goal of this nursing approach is to ensure the best possible clinical, subclinical, psychosocial, and quality-of-life outcomes for patients with MS using DMTs.
The newer disease-modifying therapies (DMTs) for multiple sclerosis (MS)—interferon beta-1a (Rebif, Avonex), interferon beta-1b (Betaseron) and glatiramer acetate (Copaxone)—are the first agents shown to have a direct influence on altering the course of relapsing MS and, as such, have heralded a new era in the pharmacological treatment of the disease.
However, despite the availability and use of these agents, some patients with MS may continue to experience relapses, disease progression, and a poor quality of life. Traditionally, improving these outcomes has focused on ensuring adherence to therapy by managing treatment- related adverse events. Adherence to therapy, however, is only one factor that is important in ensuring optimal medical and health outcomes for patients using DMTs. Other important factors that have an impact on the overall clinical and health status of patients include patient appropriateness for therapy and readiness to initiate treatment; treatment efficacy; adequate education about MS, available therapies, and self-injection training; monitoring and management of possible treatment-related adverse events; and the patient's physical, cognitive, and psychosocial status.
Achieving optimal patient outcomes is greatly influenced by the healthcare team's collaboration and assistance in identifying and overcoming problems in each of these areas. Therefore, in late 2002, MS nurses from Canada and the United States convened in Montreal, Quebec, Canada, to develop an evidence-based resource outlining nursing strategies to address potential problems that may affect the patient's overall health status and thereby achieve optimal treatment outcomes for MS patients. The result of their extensive work and collaboration is the Nursing Approach (Fig 1) presented in this paper.
(Enlarge Image)
Nursing approach to long-term treatment optimization in individuals with MS using DMTs
Optimization is formally defined as the "act, process, or methodology of making something as fully perfect, functional, or effective as possible" (Merriam-Webster On-Line, 2002). Therefore, for this nursing approach, treatment optimization refers to the process used to ensure the best possible clinical, subclinical (e.g., magnetic resonance imaging [MRI]), psychosocial, and quality-of-life outcomes for patients with MS using DMTs.
The purpose of this paper is to guide and assist nurses through this challenging, long-term process of treatment optimization. In the first three steps of the Nursing Approach—initial assessment and patient selection, treatment selection, and patient education and self-injection training—strategies are provided to ensure that the patient is both suitable for and ready to initiate DMT, that the patient receives the most appropriate therapy possible, and that the patient receives adequate education about MS and the available therapies as well as self-injection training. For the latter steps—long-term clinical, MRI, laboratory, and psychosocial assessments and the monitoring of treatment adherence—strategies are provided for suboptimal responses on any one of these parameters. The ultimate goal in each step of this Nursing Approach is to optimize the treatment of patients with MS using DMTs.
The introduction of disease-modifying therapies (DMTs) for multiple sclerosis (MS) over the last 7 years has had a significant effect on the management of those living with this disease. Initially, the focus of improving treatment outcomes was on ensuring adherence to therapy by managing drug-related adverse events. However, treatment adherence is only one facet of ensuring optimal health outcomes for patients using DMTs. Therefore, a group of 80 nurses from Canada and the United States (The North American MS Nurses' Treatment Optimization Group) developed an evidence-based nursing approach to address the various factors involved in obtaining optimal patient outcomes. The goal of this nursing approach is to ensure the best possible clinical, subclinical, psychosocial, and quality-of-life outcomes for patients with MS using DMTs.
The newer disease-modifying therapies (DMTs) for multiple sclerosis (MS)—interferon beta-1a (Rebif, Avonex), interferon beta-1b (Betaseron) and glatiramer acetate (Copaxone)—are the first agents shown to have a direct influence on altering the course of relapsing MS and, as such, have heralded a new era in the pharmacological treatment of the disease.
However, despite the availability and use of these agents, some patients with MS may continue to experience relapses, disease progression, and a poor quality of life. Traditionally, improving these outcomes has focused on ensuring adherence to therapy by managing treatment- related adverse events. Adherence to therapy, however, is only one factor that is important in ensuring optimal medical and health outcomes for patients using DMTs. Other important factors that have an impact on the overall clinical and health status of patients include patient appropriateness for therapy and readiness to initiate treatment; treatment efficacy; adequate education about MS, available therapies, and self-injection training; monitoring and management of possible treatment-related adverse events; and the patient's physical, cognitive, and psychosocial status.
Achieving optimal patient outcomes is greatly influenced by the healthcare team's collaboration and assistance in identifying and overcoming problems in each of these areas. Therefore, in late 2002, MS nurses from Canada and the United States convened in Montreal, Quebec, Canada, to develop an evidence-based resource outlining nursing strategies to address potential problems that may affect the patient's overall health status and thereby achieve optimal treatment outcomes for MS patients. The result of their extensive work and collaboration is the Nursing Approach (Fig 1) presented in this paper.
(Enlarge Image)
Nursing approach to long-term treatment optimization in individuals with MS using DMTs
Optimization is formally defined as the "act, process, or methodology of making something as fully perfect, functional, or effective as possible" (Merriam-Webster On-Line, 2002). Therefore, for this nursing approach, treatment optimization refers to the process used to ensure the best possible clinical, subclinical (e.g., magnetic resonance imaging [MRI]), psychosocial, and quality-of-life outcomes for patients with MS using DMTs.
The purpose of this paper is to guide and assist nurses through this challenging, long-term process of treatment optimization. In the first three steps of the Nursing Approach—initial assessment and patient selection, treatment selection, and patient education and self-injection training—strategies are provided to ensure that the patient is both suitable for and ready to initiate DMT, that the patient receives the most appropriate therapy possible, and that the patient receives adequate education about MS and the available therapies as well as self-injection training. For the latter steps—long-term clinical, MRI, laboratory, and psychosocial assessments and the monitoring of treatment adherence—strategies are provided for suboptimal responses on any one of these parameters. The ultimate goal in each step of this Nursing Approach is to optimize the treatment of patients with MS using DMTs.
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