Nurse Practitioner-led Care Improved Depression, Anxiety in People with MS

Delays and difficulties in making appointments with neurologists are key barriers interfering with optimal care people for with multiple sclerosis (MS), Canadian researchers wrote in a recent BMC Neurology article.

In fact, a recent online survey of Canadians living with MS found that 70% experienced challenges in obtaining appointments with their neurologists. Even when meeting with healthcare providers, multiple studies reported that MS patients do not receive enough education or support from their providers in order to meet their needs.

Penny Smyth

As a result, Penny Smyth, M.D., associate professor in the Division of Neurology at the University of Alberta College of Health Sciences and colleagues evaluated the effect of add-on nurse practitioner-led care for depression and anxiety.

The study and program were paid for through the University Hospital Foundation via a donor who “had visions of improving the care delivery to people with MS followed by general neurologists,” Smyth told Managed Healthcare Executive®.

Related: Studies Find MS Patients Need Early Help for Pain and Anxiety

Here is how the program worked: 228 people with MS at community neurologists were randomized to add-on nurse practitioner-led or usual care (community neurologist, family physician) for six months.

Study subjects were highly educated (71%), working full-time (41%), living independently (68.86%). Their mean duration since MS diagnosis was 12.18 years and 85% had relapsing remitting MS.

Patients in the intervention group received a comprehensive consultation with a nurse practitioner. The consultation included patient history, a physical examination, individualized symptomatic strategies (lifestyle strategies, mobility issues, fatigue, spasticity, bladder and bowel concerns, depression or anxiety, and medications), exploration of the MS patient’s local community, discussion of resources to optimize mood and quality of life, and regular follow up visits at three and six months, either in-person, via telehealth\ or via phone call.

The mean change in the nurse practitioner-care group’s Hospital Anxiety and Depression Scale at3 months was -0.41 compared to 1.11 in the usual care group, a difference that was present at six months. For anxiety, the mean change was − 0.32 in nurse practitioners group versus 0.42 in the usual care group.

"Care led by a nurse practitioner can improve depression and anxiety levels of people with MS over the short term. These are important comorbidities for people with MS that are known to be associated with lower quality of life,” Smyth told Managed Healthcare Executive®.

The study provides an alternate and possibly cost-saving management strategy for complex management of symptoms and quality of life measures for MS patients, Smyth wrote.

“It has been suggested that NPs (nurse practitioners) might be easier to access and less costly to see than physician health providers for people with multiple sclerosis. The use of specialized MS NPs in general neurology outpatient settings could potentially address some of these unmet needs that various researchers have identified including healthcare access, education, counseling and support, and support to informal caregivers of people with MS,” Smyth wrote.

While nurse practitioner-led care improved depression and anxiety scores, other secondary outcomes were not significantly different. In addition, the researchers did not see a difference in satisfaction of care

The research team had wanted to determine overall healthcare savings of the nurse practitioner program, but could not, Smyth told Managed Healthcare Executive®. "The patients really did not keep up their healthcare visit diaries reliably to look at outpatient in addition to inpatient costs.”