Effective Multiple Sclerosis Management Through Improved Patient Assessment

Amy Perrin Ross, MSN, MSCN, APRN, CNRN, Natalie Hackbarth MSCN, RN, Christine Rohl, MSN, CNS, CNRN, FNP, Kristi Whitmyre, BA

Disclosures

J Neurosci Nurs. 2008;40(3):150-157. 

In This Article

Using Patient Questionnaires for Self-Assessment

Important components of any MS management plan include accurate and up-to-date patient histories and patient education about the disease and available treatment. Healthcare professionals, support groups, literature, and Web sites all can serve as education resources. Management plans also should address the benefits patients expect to receive from therapy and strategies to manage symptoms and adverse effects. Management plans and detailed patient histories take a great deal of time to develop, however, and are dependent on a patient's ability to provide accurate information. Many patients with MS might focus on one symptom they experience and not mention other symptoms they experienced in the past. As a result, practitioners are not able to effectively manage all of a patient's symptoms. A nursing advisory board comprising MS nurse experts from the Midwest, sponsored by EMD Serono, Inc., and Pfizer, Inc., recently convened to discuss management approaches that have the potential to enhance DMD compliance. In our combined experience, MS patient intake and follow-up questionnaires, administered before or during patient visits to a healthcare professional's office, were found to be useful tools. These closed-ended questionnaires feature multiple-choice and short-answer questions related to the purpose of the visit, current medication, adherence, treatment expectations, disease symptoms, side effects, psychological parameters, and socioeconomic aspects. The information may be entered into a database and can be used to follow factors such as disease status, response to therapy, perception of therapy, and compliance for each patient. Patient questionnaires can increase communication between patients and healthcare providers and may help increase patient satisfaction, improve disease management, and facilitate office and clinic visits by helping to prioritize issues that need to be addressed in a single visit.

A recent analysis that used a self-report questionnaire to classify a patient's clinical course found that patient self-reporting may help to define the different courses of MS (Bamer, Cetin, Amtmann, Bowen, & Johnson, 2007), suggesting that questionnaires are an effective way to assess disease course and symptoms. The intake and follow-up questionnaires we have developed (Figs 1 and 2) have emerged as valuable tools for improving communication among physicians, nurses, and patients. They also helped increase communication among patients' family members, employers, coworkers, and friends. The questionnaire was developed by MS nurses with involvement from their patients. Literature was reviewed to identify any missing items.

Patients complete an intake questionnaire (Fig 1) during their initial visit to their healthcare provider. This initial assessment gathers detailed information about the patient's physical and psychological condition by using specific, closed-ended questions to determine symptoms, medications, and clinical status. At follow-up visits, either the intake questionnaire or a follow-up questionnaire (Fig 2) may be used, depending on the healthcare provider. The follow-up questionnaire is an in-depth self-assessment of disease progression, DMDs, DMD compliance, adverse effects associated with DMDs, adverse-effect management, and other issues related to MS disease management. The intake questionnaire may be used at follow-up to provide consistent information between visits, or the follow-up questionnaire may be used to target the specific nature of the follow-up visit.

Intake Questionaire

Follow-Up Questionaire/Symptom Report Card

Information obtained with questionnaire use can serve as the backbone for establishing patient databases for offices or clinics. Such databases may be used to help monitor disease progression and DMD response and compliance and manage adverse effects. The data also can be used to identify and recruit patients for new clinical trials. Because databases make it possible to track information between visits, they also may be used to track when adverse effects are increasing or compliance is decreasing, which gives nurses the ability to modify treatment approaches as needed.

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