Implementation study of the 2021 German guideline for diagnosis and treatment of multiple sclerosis

• Published in: Multiple sclerosis and related disorders 2022-01, Vol.57, p.103434-103434, Article 103434
• Main Authors: Mokry, C, Warnke, C, Gehring, K, Hegen, H, Salmen, A, Kraemer, M, Kleiter, I, Fasshauer, E, Scheiderbauer, J, Lühmann, D, Köpke, S, Berthele, A, Heesen, C
• Format: Article
• Language: English
• Subjects: Germany; Humans; Immunotherapy; Implementation study; Multiple Sclerosis - diagnosis; Multiple Sclerosis - therapy; Multiple sclerosis practice guideline; Neurology; Pulsed MS therapies; Referral and Consultation; Surveys and Questionnaires; Treatment algorithm; Treatment stop
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2021.103434

•first implementation study of a clinical practice guideline in MS.•early aggressive treatment and treatment stop as major areas of controversy.•overall agreement in survey data.•low participation rates among neurologists.•improved implementation strategies are needed. In May 2021, a new guideline on the diagnosis and treatment of multiple sclerosis and related disorders was released in Germany. Since the success of a guideline depends on how it integrates into everyday clinical practice, the German Society for Neurology (DGN) has launched a multimethod implementation project. Here we report on the results based on the consultation version of the guideline. We used qualitative and quantitative data analyses to capture the nature and extent of barriers and facilitating factors to the implementation. We centered on the guideline's chapter A on diagnosis, relapse therapy, and immunotherapy of multiple sclerosis. We performed nine online focus group discussions and a web-based survey and analyzed emails and letters with comments from stakeholders and independent parties that were sent spontaneously or by invitation. 94 neurologists answered the survey, and ≥70% agreed with the recommendations of the guideline on each major content topic. Barriers to implementation were detected in group discussions and written input. The most controversial issues of the guideline were “early treatment”, “criteria for starting or switching therapy”, “stepwise escalation versus early aggressive treatment”, “classification of drugs into three categories of efficacy” and the scenarios on “treatment cessation”. Some appreciated the highly structured recommendations, but others felt that the guideline restricts the free choice of therapy, or they were afraid of recourse claims. Some considered the guideline as too cautious regarding treatment initiation, possibly delaying necessary therapies. Others appreciated that conflicts of interests of the guideline's authoring group were minimized and thought that the new guideline is clearer, more extensive and practical. In contrast to the survey, feedback in the focus group discussions and from individuals was diverse and sometimes more critical. Based on the overall feedback rate of about 250 people in relation to the number of 6500 board-certified neurologists in Germany, the overall appreciation of the guideline can only be considered as an indicator and not proof of acceptance. Results of this analysis were incorporated into several ad