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Sci."],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The objective of this study was to develop a shared-care model to enable primary-care physicians to participate more fully in meeting the complex, multidisciplinary healthcare needs of patients with multiple sclerosis (MS).<jats:bold><jats:italic>Design:<\/jats:italic><\/jats:bold>The design consisted of development of consensus recommendations and a shared-care algorithm.<jats:bold><jats:italic>Participants:<\/jats:italic><\/jats:bold>A working group of 11 Canadian neurologists involved in the management of patients with MS were included in this study.<jats:bold><jats:italic>Main message:<\/jats:italic><\/jats:bold>The clinical management of patients with multiple sclerosis is increasing in complexity as new disease-modifying therapies (DMTs) become available, and ongoing safety monitoring is required. A shared-care model that includes primary care physicians is needed. Primary care physicians can assist in the early detection of MS of individuals presenting with neurological symptoms. Additional key roles for family physicians are health promotion, symptom management, and safety and relapse monitoring of DMT-treated patients. General principles of health promotion include counseling MS patients on maintaining a healthy lifestyle; performing standard screening measures; and identifying and treating comorbidities. Of particular importance are depression and anxiety, which occur in &gt;20% of MS patients. Standard work-ups and treatments are needed for common MS-related symptoms, such as fatigue, pain, bladder dysfunction, sexual dysfunction, spasticity, and sleep disorders. Ongoing safety monitoring is required for patients receiving specific DMTs. Multiple sclerosis medications are generally contraindicated during pregnancy, and patients should be counseled to practice effective contraception.<jats:bold><jats:italic>Conclusions:<\/jats:italic><\/jats:bold>Multiple sclerosis is a complex, disabling illness, which, similar to other chronic diseases, requires ongoing multidisciplinary care to meet the evolving needs of patients throughout the clinical course. Family physicians can play an invaluable role in maintaining general health, managing MS-related symptoms and comorbidities, monitoring for treatment-related adverse effects and MS relapses, and coordinating allied health services to ensure continuity of care to meet the complex and evolving needs of MS patients through the disease course.<jats:bold><jats:italic>R\u00c9SUM\u00c9:<\/jats:italic><\/jats:bold><jats:bold>\u00c9laborer un mod\u00e8le de soins partag\u00e9s dans les cas de scl\u00e9rose en plaques r\u00e9currente-r\u00e9mittente.<\/jats:bold><jats:italic><jats:bold>Objectif:<\/jats:bold><\/jats:italic>\u00c9laborer un mod\u00e8le de soins partag\u00e9s afin de permettre aux m\u00e9decins de premi\u00e8re ligne de mieux r\u00e9pondre aux besoins complexes et multidisciplinaires de patients atteints de la scl\u00e9rose en plaques (SP).<jats:italic><jats:bold>Conception :<\/jats:bold><\/jats:italic>Recommandations r\u00e9sultant d\u2019un consensus et \u00e9laboration d\u2019un algorithme en mati\u00e8re de soins partag\u00e9s.<jats:italic><jats:bold>Participants :<\/jats:bold><\/jats:italic>Un groupe de travail form\u00e9 de onze neurologues canadiens impliqu\u00e9s dans la prise en charge de patients atteints de la SP.<jats:italic><jats:bold>Message-cl\u00e9 :<\/jats:bold><\/jats:italic>La prise en charge clinique de patients atteints de la SP est de plus en plus complexe dans la mesure o\u00f9 des m\u00e9dicaments modificateurs de l\u2019\u00e9volution de la maladie (MMSP) deviennent accessibles et o\u00f9 un suivi permanent en mati\u00e8re de s\u00e9curit\u00e9 est n\u00e9cessaire. Soulignons aussi qu\u2019un mod\u00e8le de soins partag\u00e9s incluant les m\u00e9decins de premi\u00e8re ligne est n\u00e9cessaire. Ces professionnels peuvent permettre un d\u00e9pistage plus rapide de la SP chez des individus pr\u00e9sentant des sympt\u00f4mes neurologiques. Ils peuvent aussi jouer un r\u00f4le de premier plan en mati\u00e8re de promotion de la sant\u00e9, de soulagement des sympt\u00f4mes et de suivi de patients trait\u00e9s avec des MMSP en ce qui a trait \u00e0 leur s\u00e9curit\u00e9 et \u00e0 de possibles rechutes. Parmi les principes g\u00e9n\u00e9raux de promotion de la sant\u00e9, on peut inclure les suivants : offrir aux patients atteints de la SP des conseils leur permettant de maintenir de saines habitudes de vie ; adopter des mesures de d\u00e9pistage standards ; identifier et traiter les comorbidit\u00e9s. \u00c0 cet \u00e9gard, l\u2019anxi\u00e9t\u00e9 et la d\u00e9pression sont d\u2019une importance particuli\u00e8re et sont fr\u00e9quemment signal\u00e9es (&gt; 20 %) chez les patients atteints de SP. Des d\u00e9marches d\u2019investigation et des traitements standards sont n\u00e9cessaires dans le cas des sympt\u00f4mes courants reli\u00e9s \u00e0 la SP, par exemple de la fatigue, des douleurs, une dysfonction v\u00e9sicale, des dysfonctions sexuelles, de la spasticit\u00e9 et des troubles du sommeil. On l\u2019a dit, un suivi permanent s\u2019impose dans le cas de patients b\u00e9n\u00e9ficiant d\u2019un traitement sp\u00e9cifique avec des MMSP. Les m\u00e9dicaments associ\u00e9s \u00e0 la SP sont g\u00e9n\u00e9ralement contre-indiqu\u00e9s durant la grossesse de sorte qu\u2019on devrait conseiller aux patients d\u2019adopter des m\u00e9thodes de contraception efficaces.<jats:italic><jats:bold>Conclusions :<\/jats:bold><\/jats:italic>La SP est une maladie complexe et invalidante qui, \u00e0 l\u2019instar d\u2019autres maladies chroniques, exige des soins multidisciplinaires continus afin de r\u00e9pondre, en lien avec un tableau clinique pr\u00e9cis, aux besoins en constante \u00e9volution des patients. Les m\u00e9decins de premi\u00e8re ligne peuvent jouer un r\u00f4le irrempla\u00e7able \u00e0 plusieurs \u00e9gards : dans le maintien d\u2019une bonne sant\u00e9 ; le suivi et le soulagement des sympt\u00f4mes et des comorbidit\u00e9s reli\u00e9s \u00e0 la SP ; le suivi des rechutes et des effets ind\u00e9sirables associ\u00e9s aux traitements. N\u2019oublions pas non plus la coordination des services param\u00e9dicaux afin d\u2019assurer, durant l\u2019\u00e9volution de la SP, une continuit\u00e9 des soins r\u00e9pondant aux besoins complexes et en constante \u00e9volution des patients atteints de cette maladie.<\/jats:p>","DOI":"10.1017\/cjn.2018.7","type":"journal-article","created":{"date-parts":[[2018,5,14]],"date-time":"2018-05-14T09:46:33Z","timestamp":1526291193000},"page":"304-312","source":"Crossref","is-referenced-by-count":9,"title":["Toward a Shared-Care Model of Relapsing-Remitting Multiple Sclerosis: Role of the Primary Care Practitioner"],"prefix":"10.1017","volume":"45","author":[{"given":"Jiwon","family":"Oh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Sarah","family":"Gagn\u00e9-Brosseau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Guenette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Larochelle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Lemieux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suresh","family":"Menon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah A.","family":"Morrow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Poliquin-Lasnier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal","family":"Roy-Hewitson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Rush","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Marie","family":"Trudelle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul S.","family":"Giacomini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2018,5,14]]},"reference":[{"key":"S0317167118000070_ref56","doi-asserted-by":"publisher","DOI":"10.1111\/ene.12695"},{"key":"S0317167118000070_ref16","unstructured":"MS Brain Health \u2013 Time Matters. 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