Maintaining Multiple Sclerosis Care With Virtual Visits

Stephen Krieger, MD


November 10, 2020

This transcript has been edited for clarity.

Hi. I'm Dr Stephen Krieger from the Corinne Goldsmith Dickinson Center for Multiple Sclerosis at Mount Sinai in New York. Today I'd like to speak with you about how we have adapted to care for patients with multiple sclerosis (MS) in the era of virtual health and the unfortunately ongoing COVID-19 pandemic.

A lot of attention has been paid to COVID and MS. I'm not going to talk about the direct implications of the pandemic on MS, but rather how we are working to deliver care and maintain continuity for people with MS during this period. I'll also share some things that we've adopted in our own practices that perhaps you may find helpful.

For the majority of the pandemic, we have transitioned most of our MS care to be virtual telehealth and teleneurology. I have previously discussed how we perform neurologic exams over video visits and telehealth. Today, I'll focus instead on what we do during patient visits and how virtual health for patients with MS has a different feel than when we saw them in office in the past.

For one thing, seeing our patients in their homes affords a particular window into the way their MS diagnosis intersects with their life outside of a typical office visit. I think a lot can be garnered and learned from seeing a patient walking around and otherwise navigating their home environment. Sometimes I have had the opportunity to see family members of my patients whom I've never met before or who weren't able to come to visits. Some of my younger patients have brought the tablet or the laptop over for me to meet their parents, which I haven't done before. There has been something more intimate about the virtual health visits than we were even able to achieve in the office. That's not something that I anticipated at the beginning of adopting telehealth.

In terms of how we provide MS care, we have tried to ensure that there has been no interruption to treatment with disease-modifying therapies for our patients during this period. That has meant ensuring that they are being adherent using the necessary lab and MRI monitoring, and doing so in as safe of a way as possible. Sometimes we have spaced out some of the monitoring labs a little bit to minimize their trips to the healthcare facilities during the pandemic. But in general, we don't want to let safety monitoring lapse just because we're providing virtual care.

We've tried to ensure that our patients are taking adequate amounts of vitamin D. That's something that MS specialists have cared about for a long time. It's a particular concern this year, when so many people have not been going outside and didn't spend their summers outdoors as they might have in prior years. Therefore, ensuring that patients get enough vitamin D has been important.

Similarly, I've really made an emphasis on ensuring that my patients with MS are not getting deconditioned during periods of self-isolation, quarantine, or social distancing. I've been encouraging patients to be as physically active as their disease allows them to be, maintaining an exercise regimen at home, whether on their own or using online classes or video tutorials. For many patients, these things have replaced going to the gym, being part of active groups, or even going to physical therapy centers. Preventing deconditioning and loss of stamina has been an important goal during these past several months.

Emotional health is another important consideration. Of course, people with MS have concerns about their disease, especially as it is an autoimmune condition. Thankfully, we've been able to spend time informing them that people with MS haven't had higher rates of contracting COVID-19 or mortality as a result than people without MS. That has been a largely reassuring message.

But I'm also focused on the emotional consequences of social distancing, isolation, and other factors during this period of great national and international concerns. Because of this, I've probably seen my patients a little bit more regularly over video visits than I might have in normal times. It's much easier for them to have the visit. They don't have to commute all the way to our offices to be seen. In general, the ability to more regularly schedule visits for patients who might be going through periods of depression, anxiety, or other unease has been really great. I've been able to see people more frequently than I probably would have if they had to give up a half day or whole day of work to travel for a visit.

Although the type of comprehensive care we seek to provide for MS has been made in some ways more difficult by the pandemic and virtual care, it has been a little bit easier to see people with more regularity and be focused on such topics as symptom management or emotional well-being.

From a practice management perspective, I would add that we're able to bill these virtual visits for time as though they are true visits, because they really are. It's a face-to-face encounter done over video. It remains to be seen how much of our care will stay video-based and virtual in the future, but for the moment, I think we've made the best of it.

I hope that these have been some helpful hints at how to provide MS care through this new medium. For Medscape, I'm Dr Stephen Krieger.

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