Original Title: Diseño de un protocolo de interacción entre atención primaria y hospital, para mejorar la detección precoz y el seguimiento de los pacientes con esclerosis múltiple

Authors' objectives: The aim of this project is to draw up and implement a protocol of actions to increase the coordination and interaction between family and community medicine (FCM) doctors and neurologists, providing them with constant updates about the numerous advances being made in the treatment of this illness. The aim is to: • Improve the health care received by patients with multiple sclerosis (MS). • Bring forward the early diagnosis of MS.

Authors' results and conclusions: One of the most important results is the documents that have been drawn up, the Bilbao Multiple Sclerosis Protocol itself, which can be found on the Osakidetza website; http://www.osakidetza.euskadi.net/r85-gkgnrl00/es/contenidos/informacion/protocolo_esclerosis/ es_osk/protocolo_esclerosis.html This sets out the essential features of the Protocol with basic information on MS and the advances that are being made and which all FCM doctors should know and handle in order to be able to attend satisfactorily to their MS patients. The aim is to provide training through continuous and updated information. Around 600 letters have been sent, informing FCM doctors about the development, treatment of patients and the way the patient’s referral neurologist can be contacted. As a consequence, FCM medics are better informed and prepared for caring for MS patients and can contact patient’s referral neurologist directly. This is a pioneering and exclusive facility offered by few health services. Patients feel better attended to, receive unified messages and reduce the duplicity of consultations, all of which go to improve their quality of life and is beneficial both for patients and for the operation of the health system. RECOMMENDATIONS AND CONCLUSIONS The Bilbao Multiple Sclerosis Protocol is a simple and necessary tool that will allow for an increase in the effectiveness of the health system as it will provide FCM doctors with specific knowledge of MS, make them reference models in the health care of these patients, thus avoiding the need to consult different specialists. Our aim is to obtain better health treatment for patients and a better perception of the quality of the health care they receive. With regard to early detection, the importance of beginning the treatment as soon as possible in order to secure a short and long-term prognosis of MS has been demonstrated. It is considered that the best strategy to reach this objective is to increase the awareness of FCM doctors by providing them with continuous information. As in the case of any illness, whether this is chronic or not, it is important to create new models of health care that are efficient and add value through collaboration between different groups. The Bilbao MS Protocol is an example of this collaboration between different levels of health care and patients, seeking reasoned and broadly agreed solutions and strategies to reach health targets. The main difficulty we found was the absence of sufficient communications channels to disseminate information such as that of the Bilbao MS Protocol. Today, the implementation of a protocol of this type requires time in order to resolve the communications difficulties with FCM doctors, which we had not foreseen. This experience may be used as a model for application to other diseases with similar circumstances to those of MS.

Authors' methods: In order to carry out this project, it was necessary to create a multidisciplinary work team made up of all the agents involved in the care of patients with MS: FCM doctors from different regions of Bizkaia, a nurse with specialist knowledge of MS, neurologists with experience in the treatment of MS, patient representatives and a research methodology consultant. This group has attended a number of meetings in person and through the Internet. The activities develops were as follows: • Data gathering. • Definition of areas for improvement with evaluable targets. • Definition of the pilot scheme. • Assessment of the pilot scheme. • Review of the preparation of results and conclusions of the scheme.

Project Status: Completed

Year Published: 2013

URL for published report: https://www.euskadi.eus/contenidos/informacion/2013_osteba_publicacion/es_def/adjuntos/D_13_09%20esclerosis%20multiple.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>