Telehealth improves access for multiple sclerosis patients

Monday, December 18, 2023

[4 MIN READ]

The pandemic opened the door to increased telehealth access for some people with multiple sclerosis.
Post-pandemic, people with multiple sclerosis who live in Washington and Alaska can still see specialists in Seattle for their condition via virtual visits.
The Providence Swedish Multiple Sclerosis Center meets people where they are. They’ve designed hybrid offerings of in-house services and virtual reality options for patients living with the disease.

Telehealth improves access for multiple sclerosis patients

For decades in Washington, the quality of care for people with multiple sclerosis often depended on where they lived. Those who lived in rural areas of the state didn’t have the same access to specialists as people living in big cities like Spokane and Seattle.

In Washington, where “there are maybe just 20 multiple sclerosis specialists serving a state population of somewhere between 7,000 to 14,000 people with multiple sclerosis,” that’s a problem, says Pavle Repovic, M.D., Ph.D., neurologist and medical director for neurology research at the Multiple Sclerosis Center at the Providence Swedish Neuroscience Institute.

Multiple sclerosis is an autoimmune disease that targets the brain and spinal cord. It’s a leading cause of disability unrelated to trauma in people younger than 40.

The disease typically shows up in one of two ways: Through sudden attacks of disability called relapses, or through a more gradual building of symptoms over years or decades called progressive MS.

Multiple sclerosis isn’t always debilitating, but it can lead to difficulty walking and wheelchair use. Traveling to a doctor’s office can be physically and mentally exhausting — not to mention financially draining due to gas, parking and even overnight stay costs.

Although the disease doesn’t have a cure, it can be managed with therapy and medical care. That’s why patients sometimes need specialist appointments.

Thankfully, in the past few years, access to specialists has opened up through telehealth.

“It’s been a dream come true to bring this level of care to communities and treat patients without requiring them to come see us in the clinic for every visit,” Dr. Repovic says.

The COVID-19 effect

Before the pandemic, insurance companies wouldn’t cover virtual visits the same way they covered in-person visits. However, once the federal government declared an emergency due to COVID-19 and established a temporary parity rule, restrictions loosened: In-person and remote visits could be compensated the same way.

Also at that time, health care providers who would normally need a medical license in a particular state to see a patient who lived there could suddenly care for patients regardless of their location. Dr. Repovic, for his part, began to see patients remotely from Washington, Alaska, Oregon, Idaho and Montana.

When the emergency rules faded, however, regular requirements came back — for the most part. In Washington, doctors can still see patients who live in the state through the use of telemedicine. They can also still see patients from Alaska remotely. That’s because Alaska is the only state to turn patient rights to virtual access into state law. Patients in Alaska with established physician care can continue to have consultations with the doctor virtually, even if they’re out of state.

“Our Alaska patients can continue seeing us without the two-day ordeal of flying to Seattle,” Dr. Repovic says.

How virtual visits factor into care

New patients must first see a doctor in person. How often they’ll need to schedule follow-up visits and whether those visits can be virtual or in person is determined based on how well they’re managing their condition, Dr. Repovic says.

“Many patients are in stable ‘cruise-control mode’ with check-ins every six months,” he says. Around one-third to one-half of neurology visits for multiple sclerosis can be virtual.

Doctors tend to see patients with multiple sclerosis in the office at least once a year. That lets them look for clues and cues that are sometimes only noticeable in person. For example, a slightly different gait could indicate a change in disease symptoms.

For that reason, telehealth services should be viewed as a good supplement, but not as a replacement, Dr. Repovic says. Telehealth visits can serve as a real-time forum for checking in on medication side effects, reviewing test results, getting referrals or troubleshooting logistical emergencies such as a job loss.

While most medically urgent situations require face-to-face exams, telehealth care can help with some types of emergencies. For example, if a snowstorm affects the roads and someone living in central or eastern Washington can’t make it to their appointment, switching to telehealth can help make sure it still takes place.

The Providence Swedish Multiple Sclerosis Center

The Providence Swedish Multiple Sclerosis Center is designed to meet patients where they are. For instance, their Adventure and Recreation Program offers in-person activities such as skiing, skydiving and kayaking, as well as virtual experiences for those who need them.

They also offer online psychiatrist and psychologist visits for mood and mental health concerns. Occupational and physical therapy services, however, are still largely kept in-house.

In addition, the team is developing new tools and technologies to help people monitor their condition remotely between their six- or 12-month appointments.

For instance, they’ve introduced a new app called Floodlight MS. The app lets people with multiple sclerosis self-administer tests and tasks to assess their coordination, walking and mental processing speed, and other tasks. Results are stored and graphed over time, allowing the patient and their doctor to review any changes in coordination.

“It’s a wonderful idea to help us as clinicians and help patients keep track of multiple sclerosis and what’s going on from week to week,” Dr. Repovic says. “Multiple sclerosis is a silent siege, and can take things away slowly.”

The app has so far seen moderate success. Some patients are interested, Dr. Repovic says, but others feel daunted by having to remember to complete the surveys. In the future, Dr. Repovic says he hopes to see more passive trackers, similar to the Apple Watch, that can help measure performance and report results for virtual appointments.

“You don’t always notice little changes, and information can potentially help fill in that information gap by systematically capturing changes between visits,” he says.

Contributing Caregiver

Pavle Repovic, M.D., Ph.D., Providence Swedish Multiple Sclerosis Center

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