Research by Dr Gemma Maxwell

All of our attendees carry out a piece of research in an area of MS clinical practice or treatment that interests them.

This project was runner up for the MS Academy MasterClass Project Award for 2017, and snapshot gives you a quick idea of what they found and why. If you want to learn more, just click through to the full research report, or follow the links within the snapshot.

If you would like to contact the alumni who did the research, drop us a line and we’ll put you in touch where possible.

 

Aim

To audit how the disease-modifying treatment alemtazumab is being provided in Sunderland (district general hospital) under a small neurology team, compared to Newcastle (the regional neuroscience centre) with its large neurology team including several multiple sclerosis (MS) specialists.

This was prompted by guidelines by the Association of British Neurologists (ABN) on prescribing disease modifying treatments in MS which state:

“Our view is that an effective and safe multiple sclerosis team, whether based at a Regional Neuroscience Centre or a District General Hospital, should include more than one MS specialist consultant neurologist” (ABN: 2015)

 

Headlines

  • Comparing the MS services at each site:
    • Sunderland’s service is provided by an MS specialist consultant neurologist and an MS specialist nurse (less than guideline criteria).
    • Newcastle has 3 MS specialists amongst its 20 neurologists, and four MS specialist nurses.
  • Standards for providing alemtazumab were checked using the standard product characteristics (EMC: 2016) through:
    • screening before,
    • monitoring until 48 months after the final course, and
    • MRI imaging throughout.
  • The researcher reviewed electronic records for all 29 patients on alemtazumab under Sunderland care, and a sample of 31 patients under Newcastle (where screening and imaging data were not available).

Key findings

The audit highlighted both positive practice and challenges to overcome.

  • Sunderland meets the majority of screening and monitoring standards, out-performing Newcastle (scroll to Discussion paragraph 5). Screening and monitoring were both very comprehensive whilst imaging for baseline and follow-up data was also carried out well.
  • Areas for improvement included:
    • urinalysis tests were routinely missed
    • pregnancy and smear results relied on patients’ self-reporting
    • more patients could have had an additional MRI to ensure their imaging data was within three months of starting treatment (although all patients had scan results from within a year prior to starting).
  • The biggest potential problem with Sunderland’s service is that it is precarious. If either one of the two specialist staff was not available anymore the patients on alemtazumab would not have any specialist cover.
  • There are no other specialist staff on site at Sunderland to discuss complex cases with. Discussions have to wait for the regional MS meeting at Newcastle.
  • There were some limitations to the research: data was only gathered via electronic record and limited data was available from Newcastle.

Core recommendations

The recommendations following research are that Sunderland’s district general hospital neurology department:

  • review the timings of their MRI imaging scans
  • create a business plan for a second MS specialist nurse, and possibly a second MS specialist consultant
  • continue to set up DAWN blood monitoring software

 

Take action

  • Read the full report
  • Contact the researcher to discuss their work (please put the name of the Snapshot as your title in our contact form)
  • Learn more about the issues raised in this report. Click the scattered links to access further information.