NICE MS Clinical Guideline (CG186) Does it help or not?

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Presentation transcript:

NICE MS Clinical Guideline (CG186) Does it help or not? Amy Bowen MA (RN) Director of Service Development 10th October 2014

A few words about process An overview of the Guideline Priorities for implementation Key recommendations A Critique of the Guideline Where it helps Where it doesn’t Implications for future research

Process 2003 2014 Scope distilled to 18 questions posed to the GDG No comprehensive description of best practice RCTs No consensus expert opinion MS only 2014 Covered all components of health care along MS journey Comprehensive description of best practice Evidence graded A-D Consensus expert opinion Similar conditions

Priorities for implementation: Diagnosis Refer suspected MS to a neurologist McDonald criteria Information Oral and written info at the time of diagnosis F2f f/u with a HP with expertise in MS within 6 weeks of dx Coordination of Care Use a multidisciplinary approach Neurologists MS nurses Physios and OTs SLT, Psych, dieititians, social care, continence specialists GPs Non-pharmacological tx Consider supervised exercise programmes for mobility and/or fatigue Tx of relapses Oral methylprednisolone 0.5g for 5 days (talk to a specialist before tx of relapse)

Other Headlines No to Annual comprehensive review Sativex Fampyra Annual comprehensive review Symptoms Disease course General health Social activity and participation Care and carers Single Point of Contact Flu vaccine

How it helps Potential to significantly improve diagnosis and experience in early phase Opportunity to improve equity in some important aspects of care Recognises role and importance of family members More mention of cognitive problems and referral to OT or neurpsychology

How it doesn’t help Weak or silent on many vital non-pharmacological interventions Weak on MS specialist nurses and AHPs with expertise in MS Silent on transition to SPMS Implication that what isn’t there doesn’t matter ? Overly medical Sativex and Fampyra

Key Research Recommendations Cognitive rehab What is the clinical and cost effectiveness of cognitive rehab? Continued relapses Is IV methylpred more clinically and cost-effective than oral? Mobility What is the optimal frequency, intensity and form of rehab for mobility problems?

Key Research Recommendations Spasticity What non-pharmacological interventions are effective in reducing spasticity Vitamin D Can Vit D slow progression?

So, who is saying what… http://www.theguardian.com/science/audio/2014/oct/08/podcast-science-weekly-extra-ms-nice