THE IMPACT OF ESTABLISHING A SPECIALIZED MULTIPLE SCLEROSIS CLINIC ON PATIENTS' QUALITY OF LIFE: EXPERIENCE FROM THE REGIONAL HEALTHCARE SYSTEM (THE KOMI REPUBLIC, 2020-2024)

Significance. Multiple sclerosis is a chronic progressive disease that significantly affects physical and mental health. Effectiveness of the multiple sclerosis management is determined not only by the availability of modern treatments but also by the organization of specialized medical care delivery. The evaluation of such organizational reforms through the lens of patient-reported outcomes, such as quality of life, is of significant practical interest. Purpose. To assess the impact of organizational changes in the neurological care system on the quality of life and key clinical-therapeutic indicators in multiple sclerosis patients in the Komi Republic. The study subject is the dynamics in patient-reported outcomes, specifically quality of life indicators measured by the SF-36 questionnaire, in patients with multiple sclerosis before and after the implementation of a centralized management model based on a specialized multiple sclerosis clinic within the regional healthcare system (the Komi Republic). Material and methods. A comparative analysis of SF-36 quality of life questionnaire data received from 248 patients in 2020 and 313 patients in 2024 was conducted. All participants were enrolled in the regional multiple sclerosis registry (n = 349 in 2020, n = 440 in 2024). In January 2021, the first specialized multiple sclerosis clinic with a multidisciplinary team was established in Syktyvkar. The methods of descriptive statistics, comparative analysis (t-test, ANOVA), and correlation and regression modeling were used. Results. A statistically significant improvement in quality of life indicators was recorded over the four-year period. The most pronounced positive dynamics were observed in mental health: Mental Component Summary score increased from 54.3 ± 12.3 to 58.2 ± 12.1. A significant improvement was registered in physical health (Physical Component Summary) - from 49.2 ± 12.8 to 50.1 ± 13.2. The most substantial changes were recorded for the Bodily Pain scale, with the mean score decreasing from 38.9 ± 23.7 to 27.9 ± 21.4, indicating a reduction in pain intensity. A significant modernization of treatment strategies has taken place. The proportion of patients receiving high-efficacy disease-modifying therapies (e.g., ocrelizumab, natalizumab, siponimod, cladribine, etc.) increased 3.6-fold - from 6.9% (n=17) in 2020 to 24.6% (n=77) in 2024. The proportion of patients not receiving therapy decreased from 19.8% to 12.8%. The conducted cluster analysis confirmed structural changes in the cohort: the proportion of patients with high quality of life increased from 25% to 31% (p