For patients with MS, additional care from a nurse practitioner improves mental health

For patients with MS, NP-led care as an adjunct improved depression compared with usual care at 3 and 6 months, with no changes in satisfaction with care.

Supplemental care by a nurse practitioner (NP) compared to usual care improves anxiety and depression among people with MS in a Canadian clinical trial by Penelope Smyth, MD, FRCPC, and colleagues at the University of Alberta.

“People with MS require specialized care throughout the decades they live with MS, but there are currently gaps and challenges in providing optimal care for people with MS,” explains Dr. Smith. “Strategies such as adding NPs to health care teams could help meet the needs of people living with chronic conditions and could potentially reduce some of the pressure that physicians feel in their practices.”

The researchers aimed to determine “if there are alternative ways of providing care to people with MS outside of physicians working in busy practices,” she continues.

“We set up this trial to see if there was an impact of additional NP care on levels of depression and anxiety among people with MS. We also wanted to see whether people with MS were as satisfied with care provided by NPs compared to usual care provided by neurologists and family physicians.

A study assigned patients to the NP arm versus usual care

The clinical trial, the results of which were published in BMC Neurology, randomized 228 MS patients treated in community neurology practices to NP-led adjunctive care (N=120) or usual care (N=108). The primary endpoint was change in Hospital Anxiety and Depression Scale (HADS) scores at month 3. Secondary endpoints included changes in HADS scores at month 6, level of satisfaction with care based on the consultant satisfaction survey at month 6, and changes in the EuroQol five-dimensional questionnaire (EQ5D), the Multidimensional Scale of Independent Functioning (MSIF ) and caregivers Health-related quality of life in MS (CAREQOL-MS) at 3 and 6 months.

Patients in the NP-led care group received a comprehensive NP consultation that included a review of patient history; physical examination; individualized strategies related to lifestyle, mobility, fatigue, bladder/bowel problems, and mood; research of the local patient community; review of resources for improving mood and QOL; and regular follow-up visits at 3 and 6 months either in person or via telehealth or phone call. Those in the usual care arm received standard care. In the usual care arm, nurse involvement was primarily limited to helping neurologists update medication lists and facilitating the initiation and renewal of disease-modifying therapies.

NP Care improves depression in MS patients

In both groups, the mean patient age was 47 years, and the mean Extended Disability Status Scale score was 2.53, indicating minimal/moderate disability. Most patients (85%) had relapsing-remitting MS.

At 3 months, the mean difference in HADS change for depression was -0.41 (standard deviation [SD]2.81) in the NP-led care group compared with 1.11 (SD, 2.98) in the usual care group (P=0.001). The mean difference in HADS change for anxiety was −0.32 (SD, 2.73) in the NP-led care group compared with 0.42 (SD, 2.82) in the usual care group.

At month 6, the mean change in HADS for depression was −0.81 (SD, 3.18) in the NP-led care group and 0.57 (SD, 3.11) in the usual care group (P=0.003). The mean difference in change for the HADS for anxiety was −0.46 in the NP-led care group compared with 0.36 (SD, 2.55) in the usual care group (P=0.04; Figure). No statistically significant differences in mean change for EQ5D and MFIS were observed between treatment groups at 3 and 6 months.

Satisfaction with care was similar between the two arms. Mean total satisfaction scores were 63.83 (SD, 5.63) in the NP-led care group and 62.82 (SD, 5.45) in the usual care group.

“There are pressures and challenges in providing care for people living with chronic conditions such as MS within the current health care environment,” notes Dr. Smith. “Healthcare systems need to explore options for care for those living with chronic conditions.”

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