By Dr Dima Dahdaleh, Consultant Neurologist, Royal Hallamshire Hospital
MS Specialists MasterClass 6, 2019
Neurology services in Sheffield cover a wide area, offering care to patients with neurological disorders including multiple sclerosis from Sheffield, Barnsley, Bassetlaw, Doncaster, Rotherham and North East Derbyshire. Reviewing the MS nurse database of patients under our care, only 35% of these live in Sheffield.
Service evaluation of where MS patients currently on treatment were coming from, and which disease modifying therapies (DMTs) they were receiving. The aim was to determine if there is variance in DMT choices across the region and explore if our service model was leading people to make different treatment choices.
Using the blueteq database I identified all MS patients currently prescribed a DMT, demographics, treatment they are on, and named consultant. Their postcode was entered into an online CCG look up tool to determine the area they live in.
Of the 824 patients receiving DMTs at present only 32% live in Sheffield. Overall patients were on one of Alemtuzumab, Cladribine, Dimethy fumarate, Fingolimod, Glatriramer acetate, Interferon beta, Natalizumab, Ocrelizumab, or Teriflunomide. Chi-square showed there was no significant difference in DMTs prescribed across the different areas except for interferon beta(p=0.001) and teriflunomide (p=0.006). The difference in interferon appears to be due to a higher percentage of 19% patients in the NED area and 12% in the Rotherham area receiving this compared to only 6% receiving this in the Sheffield area. Teriflunomide was prescribed for 14% and 13% of MS patients on DMTs in the Bassetlaw and Rotherham areas respectively compared to the 6% and 2% in the Sheffield and NED areas respectively.
The lack of significant difference in prescribing most DMTs is likely due to a consistent prescribing culture amongst MS specialists in our centre following national guidance. Although we are based in Sheffield it appears that a significant proportion of patients are followed up locally based on information we have on consultant patients are under. Distance to Sheffield doesn’t appear to be influencing decision to be on DMTs administered as infusions. Efficacy of a drug is likely more important in decision making than travel distance.
The variability in 1st line DMTs prescribed likely due to a combination of patient and prescriber factors. Assuming choice appropriate for disease severity, choice of drug is equitable as they have a similar efficacy.