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Impact of the COVID-19 Pandemic on Multiple Sclerosis Care for Veterans

Federal Practitioner. 2021 April;38(4)a:
May 11, 2021|Federal Practitioner
Jodie K. Haselkorn, MD, MPH;Heidi Maloni, PhD;Rebecca Spain, MD, MSPH;Mitchell Wallin, MD, MPH
Author and Disclosure Information

Jodie Haselkorn, MD, MPH: Dr. Haselkorn is the Director of MS Center of Excellence-West at the VA Puget Sound Health Care System and VA Portland Health Care System. She is a Professor in Rehabilitation Medicine and Adjunct Professor in Epidemiology at the University of Washington.

 

Heidi Maloni, PhD: Dr. Maloni is the Associate Director for Clinical Care, Multiple Sclerosis Center of Excellence-East, and a nurse practitioner with over 40 years of experience caring for people with multiple sclerosis.

 

Rebecca Spain, MD, MSPH : Dr. Spain is the Associate Director for Clinical Care, Multiple Sclerosis Center of Excellence-West, and Director of the VA Portland Multiple Sclerosis Regional Program in Portland, Oregon. She is Associate Professor of Neurology at Oregon Health & Science University.

 

Mitchell Wallin, MD, MPH: Dr. Wallin is Director, Multiple Sclerosis Center of Excellence-East at the Baltimore and Washington, DC VA Medical Centers. Academic affiliations include Associate Professor of Neurology at George Washington University and University of Maryland. 

Rebecca Spain: The MS Center of Excellence (MSCoE) is coming out with note templates to be available for HCPs, which we can refine as we get experience. This is s one way we can promote high standards in MS care by making these ancillary tools more productive.

Jodie Haselkorn: We are looking at different ways to achieve a high-quality virtual examination using standardized examination strategies and patient and caregiver information to prepare for a specialty MS visit.

Rebecca Spain: I would like to, in more of a research setting, study health outcomes using telehealth vs in person and start tracking that long term.

Mitchell Wallin: We can probably do more in terms of standardization, such as the routine patient reported surveys and implementing the new Consortium of Multiple Sclerosis Centers’ International MRI criteria. The COVID pandemic has affected everything in medical care. But we want to have a regular standardized outcome to assess, and if we can start to do some of the standard data collection through telemedicine, it becomes part of our regular clinic data.

Heidi Maloni: We need better technology. You can do electrocardiograms on your watch. Could we do Dinamaps? Could we figure out strength? That’s a wish list.

Jodie Haselkorn: Since the MSCoE is a national program, we were set up to do what we needed to do for education. We were able to continue on with all of our HCP webinars, including the series with the National MS Society (NMSS). We also have a Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) series with the Northwest ECHO VA program and collaborated with the Can Do MS program on patient education as well. We’ve sent out 2 printed newsletters for veterans. The training of HCPs for the future has continued as well. All of our postdoctoral fellows who have finished their programs on time and moved on to either clinical practice or received career development grants to continue their VA careers, a new fellow has joined, and our other fellows are continuing as planned.

The loss that we sustained was in-person meetings. We held MSCoE Regional Program meetings in the East and West that combined education and administrative goals. Both of these were well attended and successful. There was a lot of virtual education available from multiple sources. It was challenging this year was to anticipate what education programming people wanted from MSCoE. Interestingly, a lot of our regional HCPs did not want much more COVID-19 education. They wanted other education and we were able to meet those needs.

Did the pandemic impact the VA MS registry?

Mitchell Wallin: Like any electronic product, the VA MS Surveillance Registry must be maintained, and we have tried to encourage people to use it. Our biggest concern was to identify cases of MS that got infected with COVID-19 and to put those people into the registry. In some cases, Veterans with MS were in locations without a MS clinic. So, we’ve spent a lot more time identifying those cases and adjudicating them to make sure their infection and MS were documented correctly.

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