Diagnosis of MS: a comparison of three different clinical settings

Abstract

In order to compare a newly established diagnostic clinic with two existing clinical settings in the management of the diagnostic phase of multiple sclerosis (MS), a retrospective audit was performed over a 12-month period comparing the length of time, adherence to recently published standards and price charged in diagnosing MS in three different clinical diagnostic settings operating within the same hospital: a specifically designed demyelinating disease diagnostic clinic (DDC), a general neurology clinic (GNC) and an inpatient investigation unit (IIU). An audit tool was created to measure the standards advocated by the UK MS Society on management of the diagnostic phase of MS. The costing tool was the price charged to health authorities. A randomized retrospective case note and referral letter review method was used. The entry criterion was a confirmed diagnosis of MS documented in the medical notes following investigation during the period April 1999-April 2001. The time between referral and first appointment favoured the DDC with a mean time of 5.9 weeks, compared to 7.7 weeks for the GNC and 10.0 weeks for the IIU. The mean times between the first appointment and receipt of results were 4.7 weeks (DDC), 18.8 weeks (GNC) and 21.2 weeks (IIU). Prices ranged from pounds sterling 395-pounds sterling 790 (DDC), pounds sterling 95-pounds sterling 380 (GNC) and pounds sterling 1940-pounds sterling 2700 (IIU). This study suggests that the UK MS Society standards are achievable in most areas without excessive additional costs and provides evidence that the DDC offers a better service than other existing models.

Quality indicators for the referral process from primary to specialised mental health care: an explorative study in accordance with the RAND appropriateness method

“…Applying the inclusion criteria, 30 articles were included, whereas only three were from the database for mental health, PsycINFO. During the analyses, five categories evolved defining potential areas expected to be affected by the quality of referral information (with reference to the included papers in square brackets): timeliness and delay [31–33], attendance/drop-out [34–37], unnecessary consultations and investigations [32, 38–42], appropriateness of the referral [32, 43–53] and correctness of prioritisation of patients [36, 40, 44, 54–60]. Fifteen preliminary indicators were derived from the abstract of these five categories.…”

Delay in the diagnosis of multiple sclerosis in Croatia

“…As well, our study supported the finding that specifically designed demyelinating disease diagnostic clinic offers a better service than other existing models. [5] …”

Multiple sclerosis, from referral to confirmed diagnosis: an audit of clinical practice

“…Thus, a final accurate outpatient diagnosis of MS requires a number of investigative steps which must, by their nature, take time. The UK National Institute for Health and Clinical Excellence (NICE) guidelines recommend a timeline of 12 weeks from a patient's first referral to a diagnosis of MS, 3 and suggested that it should be no longer than 6 weeks from referral to being seen by a neurologist, and a further 6 weeks until any necessary investigations are completed.…”