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CME: Multiple Sclerosis (MS) in a Primary Care Setting: Employing Strategies for Appropriate Diagnosis and Improved Patient Outcomes

Activity Description / Statement of Need:

In this online CME self-learning program:


During the first five years of immunomodulatory therapy, one to two out of every five patients with multiple sclerosis MS stops taking their prescribed therapy. Evidence shows that one of the major determinants of how well a patient with MS adheres to therapy is the relationship the patient has with his or her healthcare provider; the degree to which a patient feels support from his or her provider is actually an independent predictor of adherence, according to a survey of patients with self-reported progressive forms of MS. The establishment of trust is dependent on the extent to which the patient feels the provider is being honest and open about prognosis, diagnosis, and treatment options. Additionally, examinations of adherence to medical therapy in general highlight the necessity of a patient’s understanding of their clinical circumstances, goals of therapy, and complexity of their medical regimen, necessitating a provider’s comprehension of the same.  Logistical factors at play in the medical system, like high drug costs and difficulty in physically obtaining medications, also deter patients from optimal compliance with prescribed therapy. One other independent predictor of adherence to therapy is severity of disability. 


One study suggests that one out of two patients with MS who discontinue taking their immunomodulatory medication does so within the first two years of therapy, putting those patients at a higher risk of worsening symptoms.  The study’s authors call for “close follow-up of these patients would be useful in avoiding early discontinuation of therapy,” and primary care physicians, who are in a good place to communicate with patients about the barriers they face, may benefit from continuing education programming focusing on these challenges.


Moreover, clinical trial evidence and professional guidelines change, and some guidelines have been updated recently.  Communicating related information to healthcare professionals in a timely manner is a demonstrated need.  The literature suggests that practicing healthcare professionals are oftentimes unable to keep up with the steady publishing of literature and evolution of clinical practice, and awareness of professional guidelines is no exception.  Recently published guidelines therefore also inherently suggest a gap in medical knowledge, if not practice, and also justify the need for educational programming.





Introduction, Disclosures



Diagnostic criteria

  • -2010 McDonald Criteria


  • -Relapsing-remitting
  • -Secondary-progressive
  • -Primary-progressive
  • -Progressive-relapsing

Dimensions in treatment

  • -Acute attacks / exacerbations
  • -Underlying disease
  • -Chronic symptoms

Patient case

-Symptom management: coordinated care

  • -Pharmacologic
  • -Nonpharmacologic
  • -Surgical
  • -Patient education
  • -The ‘ICAP’ method
  • -Symptom list and corresponding prevalence

Patient case, continued

Specific symptoms and their management

  • -Fatigue
  • -Impaired gait
  • -Spasticity
  • -Pain
  • -Bladder dysfunction
  • -Bowel dysfunction
  • -Mood disorders
    • --Pseudobulbar affect
  • -Cognitive impairment
  • -Sexual dysfunction
  • -Ataxia and tremor
  • -Summary and best practice

Adherence and persistence

  • -Prevalence
  • -Benefits
  • -Barriers
  • -Strategies




Target Audience:

Healthcare professionals specializing in geriatrics, internal medicine, neurology, primary care, or those who otherwise commonly care for patients with MS.

This program is supported by an educational grant from Questcor.

Release Date: January 03, 2014 -- Expiration Date: January 03, 2016

Faculty: Douglas R. Allington, Pharm.D., BCPS -- Michael P. Rivey, M.S., BCPS, FASHP


Learning Objectives

By the end of the session the participant will be able to:

  • Summarize the pathophysiology, symptomology, and clinical course of MS
  • Formulate strategies to encourage patients to discuss MS impact on their activities of daily living in a sensitive manner to identify problems that may be treated
  • Given a patient case, select appropriate treatment options for managing acute exacerbations of MS
  • Given a patient case, select appropriate treatment options for managing chronic symptoms associated with MS
  • Explain effective approaches to promoting patient adherence, managing adverse effects of therapy, and addressing other barriers to care*



Faculty Disclosure and Resolution of COI

 As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review ScientiaCME.


Faculty Disclosure: Douglas R. Allington, Pharm.D., BCPS has no relevant financial disclosures.


Faculty Disclosure: Michael P. Rivey, M.S., BCPS, FASHP has no relevant financial disclosures.


Disclosures of Educational Planners: Charles Turck, PharmD has no relevant financial disclosures. 


Commercial Support Disclosure: This program is supported by an educational grant from Questcor.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Take the post-test
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural and Linguistic Competence

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version

Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.