Background: The COVID-19 crisis has created unanticipated changes in health care delivery for people living with multiple sclerosis (MS). The pandemics rapid evolution has resulted in a knowledge gap about how COVID-19 has affected practice patterns of MS clinicians.
Objectives: To understand how the COVID-19 pandemic has affected clinical practice patterns of a nationwide cohort of MS clinicians across the United States.
Methods: In collaboration with the National Multiple Sclerosis Society (NMSS), we used SurveyMonkeyTM to develop a 28-item electronic questionnaire exploring MS specialists perceptions of how COVID-19 has altered how they prescribe MS disease-modifying therapies (DMTs), provide telehealth and other services, and perceive issues affecting their own well-being including re-deployment to the front lines of COVID-19 care and availability of personal protective equipment. NMSS staff sent a recruitment email containing the electronic survey link to 188 clinicians who serve on regional NMSS Healthcare Provider Councils across the United States, 86 of whom were MS specialist physicians.
Results: Eighty-six respondents (45.7% of 188 clinicians) from 32 U.S. states completed the survey including 45 physicians, 18 rehabilitation therapists, 7 psychologists, 8 advanced practice clinicians, 4 social workers, 2 nurses, a pharmacist and a researcher. More than 80% of all respondents working on-site in a health care setting believed they have adequate personal protective equipment, while only 41.6% indicated they could safely distance themselves from others at work. Nearly 10% of respondents reported they had been re-deployed to the front lines of COVID-19 patient care, and an additional 16.9% anticipated being re-deployed. The physician subgroup had a 54% response rate and included 41 neurologists, 3 physiatrists and 1 family physician. More than one-third of the participating MS specialist physicians indicated that since the pandemic began, they use telemedicine to provide more than 75% of their clinical care. More than 80% believed COVID-19 may have changed how they prescribe DMTs. DMTs prescribed more often during the pandemic included ?-interferons (28.6% of prescribers), natalizumab (23.8%) and glatiramer acetate (21.4%). DMTs prescribed less often included alemtuzumab (64.2%), cladribine (52.4%), and B cell-depleting agents including ocrelizumab and rituximab (50%). Some MS specialists reported suspending certain DMTs during the pandemic (21.4% for alemtuzumab and 16.7% for B cell-depleting agents) or extending the dosing intervals (38.1% for natalizumab and 11.9% for fingolimod and siponimod).
Conclusions: In this nationwide survey, MS specialist physicians and other clinicians serving on regional NMSS Healthcare Provider Councils across the US reported profound changes in how they are delivering MS care during the COVID-19 pandemic.