Dr Mary Ann Picone shares her experience with telehealth care and provides resources for patients and physicians to manage multiple sclerosis treatment in the post-COVID era.
Mary Ann Picone, MD: It was definitely a challenge, especially in the beginning, when none of us knew what to expect and how serious things were going to be. We were trying to keep patients safe. Fortunately, we were able to transition to telehealth visits, so we didn’t stop seeing patients. We continued to see patients for follow-ups through telehealth. There was an app that patients downloaded so that we could see them and, as best as possible, monitor how they were doing. If they needed blood work done, we could email them prescriptions. They could do them at a local lab. But we were able to continue to see patients with telehealth.
June Halper, MSN, APN-C, MSCN, FAAN: What about patients with a UTI [urinary tract infection] or relapse?
Mary Ann Picone, MD: Those patients had to come in. We needed to see them in person to be treated with steroids or have other infusions. We used all the proper precautions, but they were able to come in to be treated. For the intravenous therapies, for patients who were on them and needed to have infusions, some were delayed. For others, we were able to have patients come in so that they didn’t progress. That was the dilemma: we wanted to keep patients safe, but we didn’t want the disease to get worse. For emergency patients, patients who needed their infusions, they came in. Otherwise, we were able to do telehealth visits.
June Halper, MSN, APN-C, MSCN, FAAN: What about a newly diagnosed patient, somebody who presented with new symptoms? How did you handle that?
Mary Ann Picone, MD: That was tough. We delayed seeing some new patients because you need to see a new patient in person. You can’t do that over telehealth. For the first couple of months of the pandemic, we had a delay in seeing new patients. But then we got them in for visits because we didn’t want to have them progress or not go without treatment.
June Halper, MSN, APN-C, MSCN, FAAN: Did they start with new patients with new disease-modifying therapy? Did the MSAA [Multiple Sclerosis Association of America] website help in terms of education?
Mary Ann Picone, MD: We try to refer patients to Multiple Sclerosis Association of America as much as possible as an online resource for education. There’s a lot of information on the internet, but some of it can be misleading to patients. It’s important to have a site that’s well researched, that you know is reliable information. We referred patients to MSAA. With the resources it has available, if patients needed equipment, that was very helpful. We utilized that a lot.
June Halper, MSN, APN-C, MSCN, FAAN: Gina, what’s the importance of credible information? I’m sure you get some very weird phone calls, but you’ve got a lot of resources to refer patients to.
Gina Murdoch: It’s critical that patients get correct information. They’re making serious decisions about medication protocols, treatment, and what they need to do. They need to base those decisions on credible information. It’s absolutely important that patients have access to resources so they can be heard, so they can have conversations with their health care provider. There’s a lot of information out there. There are wonderful websites, like MSAA, for their research. CMSC [Consortium of Multiple Sclerosis Centers] is a great resource as well. We make sure patients can go to those websites, where the information is vetted and medically sound. We have our chief medical officer review all our information as well. If we’re putting something up, we want to make sure we base our organization, our information to patients or providers, on medical credentialing. It’s absolutely critical to get that information into the hands of patients, who are making lifelong decisions on treatment, on what they want to do with their MS. Being that resource is really important.
June Halper, MSN, APN-C, MSCN, FAAN: Dr Picone, what information or support would you offer a primary care [physician] or community neurologist facing challenges? You’re blessed with an MS center with all kinds of resources. But in the middle of the country—in Nebraska, for example—we have a single neurologist trying to take care of 10 to 20 patients with MS. It’s a complicated disease.
Mary Ann Picone, MD: It is. There’s been much improvement over the years, but it’s a chronic illness, so you need the support. It’s not just medication. You need to have a team. The best care for patients is if they have team support. That includes physical therapy and occupational therapy.
June Halper, MSN, APN-C, MSCN, FAAN: What about Nebraska?
Mary Ann Picone, MD: In those cases, 1 good thing that’s come out of the pandemic is some of these technological resources. Even for rural patients, physicians can more have online consultations, patients can do telehealth visits with a mental health professional or social worker. Even if there’s no access because of transportation or other hindrances, telehealth visits have made a big difference in being able to access some of that care in remote locations.
Transcript edited for clarity