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Fall 2009

Delivering Comprehensive Care for MS Patients

Therapeutic and symptom management decisions for multiple sclerosis patients demand measured, individualized analysis, but physicians' time constraints can make such analysis challenging. In addition, MS patients typically need support that goes beyond traditional clinical concerns. That's one of the advantages a specialty clinic can offer.

"We have time to weigh things, the multidisciplinary expertise to comprehensively address patient care and the systems to work collaboratively with referring physicians," says Liz Crabtree-Hartman, M.D., director of patient program development at the UCSF Multiple Sclerosis Center.

"The mission of our center is to provide top-quality care and support for the MS community," says Douglas Goodin, M.D., medical director of the center. "This is critical for our current patients and their families. In addition, the center does clinical research to better understand and treat this disease."

At the center, 15 MS specialists, each focused on a distinct area of clinical research, contribute to a comprehensive care process that goes beyond disease-modifying therapies.

Expanding Access

Because a primary concern for all patients is optimizing access to care, the UCSF MS Center now holds four urgent care clinics each week. There, patients meet with a nurse practitioner and an MS expert about urgent physical symptoms as well as concerns such as depression, cognitive issues or how they're adjusting to their new diagnosis.

"We address the urgent care issue, but also wish to ensure that our patients feel cared for, as this affects quality of life," says Crabtree-Hartman.

After each appointment, a nurse practitioner calls the patient to answer questions and direct the patient to additional resources.

"The model here is ongoing, systematic therapy to address arenas including social work, physical therapy, occupational therapy and mental health care, in addition to the core decisions regarding disease-modifying therapy," says Crabtree-Hartman.

Expanded Programs Beyond the Clinic

Outside of the clinic and follow-up care, Crabtree-Hartman has initiated a series of supportive services. The first is an orientation meeting that she and Mary Owen, nurse practitioner, conduct for newly diagnosed patients.

"The orientation gives them an overview of our current understanding of MS," says Crabtree-Hartman. "Often there isn't time for extensive education during the initial patient encounter."

For ongoing support, she and Owen run a monthly, two-hour, topic-driven meeting. During the first part, prominent speakers talk about issues ranging from managing pain to imaging advances and vitamin D. The remainder of the time is open discussion that typically ranges far beyond the evening's chosen topic.

"It's really morphed into a wonderful therapeutic community," says Crabtree-Hartman.

Crabtree-Hartman also oversees a quarterly educational series on the latest research, in partnership with the National Multiple Sclerosis Society. For patients who prefer to connect electronically, she is working with neurologist Darin Okuda, M.D., to build a series of Internet-based patient education programs.

Crabtree-Hartman views these programs as optimal, multidisciplinary patient care and an important community resource. Collaboration with referring neurologists is a critical aspect, which is why the center provides timely communication after each patient encounter.

In addition, says Goodin, "There is great excitement about our planned move to Mission Bay in 2011 because it will enhance this collaborative, community resource concept by putting the MS Center across the street from the National MS Society headquarters and adjacent to major neuroscience research hubs."

For more information, contact Liz Crabtree-Hartman, M.D. at (415) 353–2069.

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