People with MS have access to medical care, treatmentsand therapies appropriate to their needs.

MS is a serious condition, making access to medical care extremely important to the QOL of people with the disease. The wide range of symptoms and functional impairments that often accompany MS means that a broad array of services is needed. In addition, the twin facts that it is a long-term illness and that primary care providers may not treat many people with the disease result in a need for continuity of care by professionals who have specialized knowledge about treatment of MS. Because the time of initial diagnosis is particularly stressful, it deserves special attention from health care and other providers. Also because expert medical care is essential for people with MS, they must have access to necessary health care services including excellent diagnostic services, knowledgeable and skilled medical providers, up-todate drugs and medical treatments and services that address their symptomatic needs.

2.1. Access to Health Care

2.1.1. All people with MS must have access to evidence-based, quality health care. Ref 1,3,4,24,35,47,68

2.1.2. Health care for people with MS includes medically-effective treatments, including symptom and disease modifying drugs, rehabilitation services, appropriate and affordable enabling technology that is tailored to the needs of people with MS, and continuing care services. People with MS have access to medical care, treatments and therapies appropriate to their needs.

2.2. Initial Diagnosis

2.2.1. Physicians must be sensitive to the major psychological, social, financial, vocational and medical impact of telling a person that she or he has MS. Patients must have adequate time to ask questions of the physician. Newly diagnosed patients should be referred to the national MS Society and an MS nurse specialist or other health professional with MS treatment and counselling experience.Ref 1,12,30,32,33,35,36,40,42,47,56,103,117,129-134

2.2.2. At the time of the initialdiagnosis, people with MS must have access to information about MS that is specific to newly diagnosed individuals, together with information on local and national medical, support, rehabilitation, and life-planning services. Ref 1,30,35,36,42,54,56,63,103,106,114,133

2.3 Physicians, Nurses, Hospitals and Other Medical Providers

2.3.1. Medical care is to be provided by clinicians who have expertise in MS, including neurologists. In order to ensure prompt and expert treatment of the wide range of symptoms and disabilities that people with MS may experience, both care and case management must be provided by multidisciplinary teams that specialize in MS. Ref 1,3,4,6,16,17,27,35,42,61,65,68,103,115,119,122,24,125,128

2.3.2. As appropriate, people with MS must be offered a broad range of services beyond those provided by physicians and nurses, including physical, occupational, and speech therapy, counselling, and other services. The purpose and potential benefits of those services are to be clearly explained to them. Ref 1-,6,11,16,17,24,35-37,42,44,45,47,53,56,59,61,65,68,71-74,76-78,81,86,90,94-104,106,109,111-119,121-128,135-138

2.3.3. Medical facilities, such as hospitals, must take into account and make reasonable modifications of physical facilities and equipment to accommodate the physical disabilities of people with MS, including difficulty walking, bathing, and getting on and off examining tables. Ref 3,35,135

2.3.4. Treatment for MS must be co-ordinated with treatment for other acute and chronic medical conditions and with continuing care needs. Protocols for referrals and transferring responsibility among different providers and health care organizations should be agreed upon by all relevant parties. Services are seamless from the patient’s perspective. Ref 3,27,30,35,42,124,125,128

2.3.5. People with MS must have continuity of care with their clinical providers over an extended period of time. The focal point for continuity is a provider with sufficient time and motivation to learn about each patient’s individual experience with MS, to listen to the patient’s questions and concerns, and to explore the full range of symptoms. This provider could be an MS nurse specialist, a physician knowledgeable about MS, or another health professional who specializes in MS care.Ref 1,3,4,7,12,30,33,35,54,57,65,103,137

2.3.6. All neurologists, primary care physicians, nurses, and other health professionals who work with people with MS must have the goal of promoting QOL, and not just clinical management of the disease.Ref 1,3,4,6,12,18,19,27,30,40,45,48,49,56,65,70-72,74,76,94-97,99-102,138,139

2.4. Symptom Management

2.4.1. Medically-effective and culturally-appropriate treatments must be available to address the symptoms of MS, including (but not limited to) fatigue, depression, cognitive impairment, impaired sexual function, pain, bladder and bowel dysfunction, limited mobility, vision problems, and others. Health professionals must consider in a systematic way whether a person with MS has additional, sometimes “hidden” symptoms or problems that can affect QOL.Ref
2-4,6,7,11,16,17,19,20,35-37,40,42,44,45,47,48,
53,56,57,59,61,65,68-70,72,76-78,82,90,95-99,
101-103,105,106,109,110,112,113,115-119,121,
122,124-128,135-137,140-152