June 7, 2022

Next-level care for patients with complex disease

More than 800 Kaiser Permanente patients in Washington diagnosed with multiple sclerosis are now able to experience a higher level of support and quality care.

When Desiree Perez was diagnosed with MS, or multiple sclerosis, in 2004, she considered herself lucky since it was caught early on. Her symptoms were relatively mild and fortunately still are. But after experiencing a few challenges with the disease over the years and reaching a milestone birthday, she felt it was time to meet with a neurologist to assess how she was doing. 

“I’d schedule an annual appointment to make sure everything was OK, but because I can still run, jump, dance, and do everything I want to do, I wasn’t seeking any treatment or therapy,” said Perez. “I felt I was turning a corner and it was a good time to ‘look under the hood,’ so to speak.”

Perez had good timing. She met with Neda Zarghami, MD, a neurologist who joined Kaiser Permanente in 2020 and is working on building a multidisciplinary MS clinic with high-quality care to support patients. With new capabilities and staffing, Kaiser Permanente in Washington can provide more patient care coordinated by a nurse across the many therapies patients may need.

“Some MS patients are fine, some are bedridden — there’s a wide variety of care management needed with this disease,” said Dr. Zarghami. “With cases ranging from simple to complex, we have to dig deeper to put the pieces together and find which treatment options will best work for each patient.”

What is multiple sclerosis?

Multiple sclerosis, often called MS, is a disease that affects the central nervous system — the brain and spinal cord. It can cause problems with muscle control and strength, vision, balance, feeling, and thinking. Everyone’s experience with MS is different, and issues may be temporary or long lasting.

How does this new program support our patients?

The MS care team includes:

  • Neurology doctors who diagnose the disease, go over treatment and therapy options and create a plan, provide referrals to needed therapies such as physical or occupational therapy, and facilitate disease management
  • An MS specialist who offers second opinions and provides complex disease management.
  • A physician assistant who supplements clinical doctoral care, particularly facilitating disease management
  • A nurse care coordinator who focuses on early intervention, prevention, and coordination of care.
  • Clinical pharmacists who discuss therapies more in-depth with patient after the physician has created a plan, and assist with drug product selection in concert with the prescribing physician.

Patients with MS often require many types of medical services, including physical therapy, occupational therapy, nutritional support, and psychological care. While Kaiser Permanente provides a number of these services, scheduling separate visits at different facilities and contracting for services outside Kaiser Permanente were often still necessary.

Coordinating all visits is a convenient option for patients who may feel overwhelmed when navigating their MS treatment plan. The team helps guide patients every step of the way and get treatment sooner rather than later. The sooner patients can start different therapies, such as physical therapy, occupational therapy, or psychological care for mood disorders that often accompany MS, the better the outcome for their health and their ability to manage challenges caused by the disease.

How does our care team make a difference?

It’s important to have pharmacists on the team with a deep knowledge of MS drugs, as more than 20 of these medications need regular monitoring. It was one of these pharmacists taking the time to speak with Perez that made a significant difference in the approach she now takes to treat her MS. The pharmacist spent over an hour providing details about the infusion Perez was thinking about pursuing — explaining the science of how it works and what she could expect, as well as answering Perez’s many questions.

Perez was grateful Dr. Zarghami connected her to a pharmacist to talk about potential treatment, but the initial meeting between patient and doctor is what led Perez to think about pursuing treatment at all.

“I felt Dr. Zarghami was paying attention to me by listening to what I was saying and really hearing my story,” said Perez. “She shared the facts about where my scans showed I was at and what she thought I should do. She could sense my apprehension about treatment and helped me identify what fears were holding me back. I felt respected and understood.”