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Treating MS in a rural setting

Flo supports both patients and clinicians in a challenging healthcare environment 

Scotland has the highest prevalence of Multiple Sclerosis (MS) within the United Kingdom, whilst NHS Western Isles is amongst 6 health boards with the highest prevalence nationally.  Clinicians working with the Western Isles face a number of challenges due to the rural island setting, including adverse weather conditions and long travel times.  Flo’s simple and proven methodology is now being used to support patients and clinicians managing MS in these challenging conditions.
In 2012, a specialist MS nurse was appointed to support patients in the Western Isles, covering all nine islands and an area of 3,071km².  Taking into consideration both the challenges of rurality and geographical area to be covered, the MS nurse felt that Flo could provide patients with additional support in between their clinical contacts to improve their confidence to self-manage their condition and adhere to their prescribed treatment.

NHS Western Isles’ MS pathway now includes Flo to specifically support patients who are taking DMDs (Disease Modifying Drugs).  Dependant on the specific drug prescribed for the patient, there is a requirement for regular blood testing fortnightly, monthly, 3 monthly or 6 monthly.  Flo gently prompts patients to book these appointments, which helps to ensure patient safety by improving adherence to clinical guidelines. Having up to date blood test results which are available for review also ensures patient contact is timely and effective, which is especially important given the amount of travelling required for both patients and clinicians in the Western Isles.

Kathleen Smith is a student doctor at the University of Aberdeen, and as part of her 5th year elective, completed an evaluation of patient’s experience of using Flo for MS.  Patients were asked to complete a questionnaire about their experience of using Flo using a rating scale of 1 -10, while also providing any further comments they wished.  Additionally, two healthcare professionals involved in the initial setup and current use of Flo (TEC Project Manager and specialist MS nurse) were involved in the evaluation and completed a separate staff questionnaire.

Patient’s responded very well to Flo, and their feedback reflected how Flo’s simple, supportive messages can make a difference in giving patients the confidence to self-manage their condition:

  • 100% of patients rated Flo as extremely easy to use.
  • 87% of patients rated Flo with the highest score of 10 when asked how useful Flo was in the management of their condition, while the remaining patients rated Flo’s usefulness as 8/10 or higher.
  • 100% felt that Flo was not at all intrusive in their daily lives.

“ Great reminder for management of my MS 

Good reminder for my bloods because I often forget until I get texts ”  

I am so happy with ‘Florence’, she is so helpful

Feedback from healthcare professionals was also positive; the MS Nurse responded that Flo was easy to use, was extremely useful in the management of MS, and felt that patients engaged very well with Flo.  They also commented:

[Flo] is such a valuable support for me as a lone working clinician covering a wide geographical area… [Flo is] extremely beneficial in reducing my workload

The TEC Project Manager responded that Flo was easy to initiate in clinical practice, and that protocols are relatively easy to set up, dependent on the type of pathway and its aims.

The use of ‘Florence’ in MS management has overall impacted patient care and healthcare professionals positively.  Patients feel the service is useful and healthcare professionals feel ‘Florence’ has decreased workload.  The service is simple and also provides valuable feedback for patients.   Expansion of ‘Florence’ into other areas of healthcare, and the ability of pathways to be tailored to individual patient needs, will create new uses for the service.

It is fantastic to be able to share this evaluation, and to know that Flo is really making a difference to patient’s lives, as well as supporting clinicians who work in unique and challenging settings to provide high quality patient care.

For more information about NHS Western Isle’s MS Pathway, please contact Iain Trayner at

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