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Providing coordinated care to multiple sclerosis patients for nearly two decades

Providing coordinated care to multiple sclerosis patients for nearly two decades

June 9, 2023

Since 2004, Burnaby Hospital’s Multiple Sclerosis (MS) Clinic has provided comprehensive care to more than 4,000 patients in a territory with a population of approximately two million residents and acts as a hub for multiple sclerosis research. The clinic, partially funded by Burnaby Hospital Foundation, was recently featured in a case study by the American Academy of Neurology, recognizing the excellence in MS care that this clinic brings to the Burnaby community.

The Canadian 5C Model case study looks at the advantages of comprehensive, coordinated, community-based, close-to-home care of multiple sclerosis patients. The study notes that the ‘one-stop-shop’ approach adopted by the Burnaby Hospital Multiple Sclerosis (MS) Clinic, provides more opportunities for better patient outcomes, improved collaboration between care teams and robust recruitment and retention of physicians. The 5C model includes evaluation and management of medical, psychological, social, and rehabilitative services related to multiple sclerosis in-clinic or virtually.

The study cites the following example of why this model succeeds: “A new patient to the clinic would receive an initial multiple sclerosis diagnosis and disease modifying therapy and management from a neurologist. The patient would also receive all necessary physical and psychiatric interventions depending on their unique symptom management needs. This could include care from any combination of neuro-ophthalmology, radiology, psychiatry, rehabilitation, urology, gastroenterology, physical and occupational therapy; as there is a prioritized patient pathway for the Multiple Sclerosis Clinic patients with these specialists.”

“Patients receive care from physical medicine and rehabilitation physicians directly in the clinic and may see the other specialists in the clinic or the specialty office. Social work and primary care practitioners provide key coordination and education to patients and caregivers throughout the spectrum of care. Health units offer at-home safety assessments at home, personal care physiotherapy, or at-home occupational therapy and mental health units with access to physiatrists, psychiatric nurses and counselling also may get involved in patient care if a referral is sent from the MS Clinic.”

Because MS is a chronic condition, patients often stay with the clinic for years or even decades.

In addition to providing comprehensive care to people living with MS, the clinic is dynamically involved in research. Neurologists from Burnaby Hospital have collaborated with other Fraser Health Authority hospitals on more than 60 research projects. The clinic’s research assistants have gone on to medical school and its graduate students have cut their teeth there with eight of the 10 current neurologists having done fellowships or training on site.

As the fundraising organization for Burnaby Hospital, we bridge the gap between what the government provides and what our community needs. Our purpose is to ensure that Burnaby Hospital is equipped in every way to advance the health of all generations that will help maintain the vibrancy of the entire community. Burnaby Hospital Foundation is proud to support the Burnaby Hospital’s Multiple Sclerosis (MS) Clinic. If you would like to make a gift directed to Burnaby’s Multiple Sclerosis (MS) Clinic, please visit our website and follow the instructions below.

How to designate a gift:

• Visit
• Click on the box titled “designation”
• Click “other”
• Type “Neurology”
• Complete the steps on the donation form to submit your charitable donation