Transforming multiple sclerosis care in Italy through Integrated Care Pathways and local networks of service providers. A survey on clinical centres

Background and Objective: 240 specialised clinical centres (CCs) provide diagnosis and treatment of multiple sclerosis (MS) within the Italian National Health System (SSN). Mostly based in neurology departments, CCs were authorised in the mid ‘90s by SSN to administer the first Disease Modifying Treatments (DMTs). Increasingly widespread Integrated Care Pathways (ICPs) require CCs to coordinate multidisciplinary care and to ensure collaboration across hospital, community and social care for people with MS (PwMS). Understanding whether CC led local networks of services exist and what factors hinder of facilitate establishing them is key to design policies aimed at support transformation of MS care. Methods: The Italian MS Society (AISM) carried out a survey in early 2022 inviting all Italian CCs. The questionnaire was designed in collaboration with an advisory board including representatives from the Ministry of Health, relevant professional bodies, academics and researchers. Results: 70% of Italian CCs (n=169) completed the questionnaire and reported to follow 102,246 PwMS overall (77% of the estimated prevalent cases in Italy). 25% of participating CCs provide care based on a local ICP while 44%, 11% and 20% respectively mentioned a regional, an informal or no ICP. Presence of a local ICP was significantly associated with more collaboration with community and social care services and with reported existence of a local network of providers, compared both to no ICP and to regional ICP. Staff shortage and suboptimal IT infrastructure are reportedly the main factors hindering transformation. Conclusion: Most CCs struggle to build relationship with other providers, especially with those farther from the hospital setting and the healthcare domain. A minority of CCs reports the existence of networks in MS services. Local ICPs are effective vehicles to formalize collaboration across hospital, community and social care providers, and to facilitate the leading role of CCs’ in transforming MS care.