Presentation on theme: "The needs of MS patients and what AHP’s can provide"— Presentation transcript:
1The needs of MS patients and what AHP’s can provide Nicola CondonSenior PhysiotherapistAcute Neurology
2Patient needs….?Dependant on many factors;Type of MS and its fluctuating / variability in nature influencing disability over timeExperienced differently by individuals in variable personal circumstancesNeeds vary at different stages of disease trajectoryQOL is diminished by physical, emotional and cognitive symptoms – impaired mobility, limb weakness, poor coordination, sensory problems, fatigue, depression, pain, spasticity, cognitive impairment, sexual dysfunction, bowel and bladder dysfunction, vision and hearing problems, seizures, swallowing and breathing difficulties.Patients needs can be physical, health related, psychological, financial, employment/leisure, information/knowledge about their condition.
3Considerations… NICE MS Clinical Guidelines NSF introduced 2005 for long term neurological conditions – 11 quality requirements to improve the quality of care and putting patients at the centreBenchmarking study 2010, National Audit Office 2012 – Reviewed Needs and experiences of services by individuals with progressive neurological conditions (MND, MS, PD)KEY FINDINGSPerson Centred / co-ordinated services – Mixed experiences; 36% single health or social care professional co-ordinating their care; 22% aware of a care plan (not up to date); 27% felt given support with self management strategiesVocational Rehabilitation – vast majority not in paid work in the last 3 yearsCarers – 21% received a formal carer assessment31% increase in admissions to hospitals from to ; 14% re-admitted within 28days
4AHP’sShared AIM – ‘allow people to achieve the highest level of function and independence, through assisting people to restructure their lives, learn new skills, re-learn tasks and make significant emotional adjustments in their lives’Prevention of secondary complications which would otherwise increase burden of care, reduce QOL and accelerate disabilityWork across different care settings and geographical boundariesHospitals Primary care – in or out-patients, isolation or MDT’sCommunity Secondary care – in or out-patients, mental health, in isolation, MDT’sTertiary centres – Regional Rehabilitation centresLocal authorities social services
5Patient needsDefining the value of Allied Health Professionals with expertise in Multiple Sclerosis MS Society Trust Nov 2013Derived from an on-going project by Disability Action, Dorset HealthCare University NHS Foundation Trust and the Dorset Multiple SclerosisService, Poole Hospital NHS Foundation Trust and with their permission.Aim promoting self management and avoiding emergency or unscheduled care.
6Focus on self-management – Engagement with health services Newly Diagnosed patientPHYSIOTHERAPY – Specialist assessment, Individual exercise programme, Fitness, EducationOCCUPATIONAL THERAPIST – Patient centred assessment - Workplace assessments, Assist employers in job redesign, Fatigue management strategies, equipment needsDIETICIAN – Healthy eating, weight management, address bowel managementEDUCATION / PATIENT INFORMATION – Information days for newly diagnosed patients, Fatigue management Coursehow to access services, recognise symptoms and management, reducing anxiety / fear / stress,50% leave their jobs within a decade of diagnosisHealth and social care costs approx £17,000pp diagnosed rising to £25,000 when lost employment cost are included
7Focus on avoidance of acute admission - Supporting self management CRISIS – Patient falling at home ?emergency admissionCOMMUNITY PHYSIOTHERAPY – Rapid assessment of aids, Falls risk assessments, Re-ablementCOMMUNITY OCCUPATIONAL THERAPY – Timely home assessment, provision of equipment, Liaison with Social ServicesSOCIAL CARE – care needs, carer supportPrevent unscheduled emergency careAvailable on requestPeriodic assessment and advice = anticipatory intervention
8Facilitating discharge and access to rehab services Relapse requiring acute admissionPHYSIOTHERAPY – Specialist assessment and rehabilitation, Goal setting, Discharge planningOccupational Therapy – Specialist assessment and rehabilitation, Cognitive screening, Goal setting, Home or access visits, Equipment or adaptationsSALT – Assessment of swallowing function / speech, recommendationsORTHOTIST – Assessment for orthoticsSOCIAL SERVICES –modifications / equipment, ensure carers approach is ‘therapeutic support’Reduced length of stay and preventing re-admission.Reducing disability through early interventions.Improving QOLOngoing support and rehab
9Complex disabilities – coordinating specialist services LOCAL COMMUNITY SERVICESEXPERT V NON-SPECIALISTREGIONAL REHABILITATION UNITS-MS CLINICS- SPASTICITY SERVICES- SPLINTING / ORTHOTICS- SPECIALIST SEATING / WHEELCHAIRS- ACT SERVICES- PSYCHOLOGY SUPPORTSOCIAL CARE PROVIDERRegular re-assessments of needsSecondary complication prevention
10Challenges facing AHP services Difficult to quantify economic benefits & impact on social care costsWhich Outcome measurements?Inflexibilities in the Tariff system – focus on episodic care rather than meeting needsRising patient expectations / referrals – increased caseloads, waiting listsCrossing boundaries – communication between services, barrierNeed for further research – low quality evidenceNot easy to quantify economic benefits - AHP’s preventative in nature through enablers of self-care and self-management, enhancement of QOL (measurement pt satisfaction Q’s)avoid / delaying social care costs; may result in a person not needing GP / Neurologist appointment; maintain employmentChallenge of measuring outcomes in a degenerative condition which also fluctuates and is variable in the way it affects individuals. Measuring success, through prolonging ability for as long as possible. Eg FES providing right equipment, specialist orthotics, individually tailored exerciseInflexibilities in the Tariff system – focus on episodic care rather than meeting needs, eg. Complexity may need lengthy assessments / treatment timeCrossing boundaries – communication between services, barrierNeed for further research – low quality evidence which covers mainly relapse-remittingRising patient expectations / referrals – increased caseloads.
11ReferencesDefining the value of Allied Health Professionals with expertise in Multiple Sclerosis MS TRUST 2013NHS Tariff, , category 3 investigations with category 1-3 treatment or category 3 investigation with category 4 treatmentBeer et al (2012) Rehabilitation interventions in multiple sclerosis: an overview Journal of Neurology 259 (9) ppRietberg et al (2004) Exercise therapy for multiple sclerosis Cochrane Database of Systematic Reviews Issue 3Department of Health – National Audit office, Services for people with Neurological conditions 2012Naci et al Economic burdon of multiple sclerosis: a systematic review of the literature. PharmacoEconomics 2010;28(5):363-79McCrone et al Multiple sclerosis in the UK;Service Use, Costs, Quality of Life and Disability. PharmacoEconomics 2008;26(10):847-60National Service Frameworks 2005