*Limitations*

For a comprehensive in- and outpatient health care setting for PwMS, different health professions are relevant for IPC based on the need of care and depending on the phase of this life-long disease as physicians, neurologists, psychologists, nurses, pharmacists, podiatrists, and others including therapists. Our study was focusing on IPC in health care professionals; as therapists this means physiotherapists, occupations therapists and speech therapists. By reflection on the results, this will limit this study related to the comprehensive outpatient health care setting for PwMS. The findings of this study cannot answer the question of what the IPC experience in a strictly outpatient setting is, and how its implementation takes place. Although attempts were made to obtain outpatient results, outpatient health care professionals were not willing to make themselves available for focus groups or even individual interviews. The reason consistently given was a lack of time. To minimize the risk of losing the voice of outpatient health care professionals, one strategy was to conduct individual interviews with health care professionals in the outpatient setting before losing this information completely. However, the outpatient health care professionals were not supported to participate in a focus group during their working hours and outside their working hours they were not willing. Furthermore, the creation of outpatient focus groups was made more difficult by the different local workplaces. For future project methods, an online focus group approach could be a useful tool to include hard-to-reach health care professionals to facilitate their participation. All health

care professionals who were included worked in inpatient rehabilitative settings and were thus locally limited. The most noticeable aspect when writing to outpatient health care professionals was that it was extremely rare that PT, SLT, and OT worked all together in a strictly outpatient practice. This may indicate further organizational problems for PwMS who depend on all three forms of therapy.

By reflecting the results, we would like to acknowledge that only some of the health care professionals approached for the study agreed to participate. This means we do not know the opinion and attitudes toward IPC of those who declined.

A critical look at this work reveals that the interviews were conducted by a professional colleague and master student. This position is, in fact, an insider position, which can be advantageous, for instance, because both sides share a common language and nomenclature. In a focus group setting, the researcher has several functions such as moderator, listener, observer, and eventually analyst [26]. A disadvantage is that the interviewer's own experiences, norms, and values regarding the phenomenon to be investigated are involved. In this study, health care professionals working in inpatient, semi-inpatient and rehabilitative settings were interviewed. In contrast the personal perceptions of the author herself, working in a strictly outpatient setting, is that IPC does not exist in the outpatient care of PwMS in Switzerland. However, this observation could only be compared to a limited extent with results from this study.

## **5. Conclusions**

The study wanted to examine two research questions. On the one hand, 'What is the health care professionals' perspective regarding the meaning of IPC in a comprehensive health care of PwMS'? The findings sugges<sup>t</sup> that IPC plays a crucial role in specific inpatient MS clinics in Switzerland. Moreover, it was revealed that overall PwMS can only benefit from an IPC therapeutic approach because health care professionals work together in a goal-oriented and patient centered way. It could be shown that close location (inpatient setting) of health care professionals strongly supports the implementation of IPC.

On the other hand, the second research question, 'How does the experience with PwMS affect the health care professional's IPC?' could be answered as follows: This is a disadvantage for PwMS in outpatient settings because this possibility does not exist in Switzerland so far. In settings where individual professions work at larger distances, less or no IPC seems to take place. Further research in outpatient settings about the implementation prerequisites of IPC for PwMS and health care professionals' views is needed. The outpatient sector shows a strong dispersion of the professions, which may also make it difficult for the PwMS if an interprofessional approach should be desired. Incentives for cooperation in the outpatient sector should be created from the field of politics in order to be able to connect health care professionals caring for PwMS in Switzerland.

Health care professionals themselves and health institutions can benefit from these findings to gain an overview of their processes and possible missing contacts for outpatient IPC.

**Supplementary Materials:** The following are available online at https://www.mdpi.com/1660-4601/18 /12/6537/s1, Figure S1: Extract from MAXQDA Coding, Figure S2: MAXQDA Main Sets.

**Author Contributions:** F.S.: reviewed the literature; study administration; data collection and analysis; wrote manuscript; edited manuscript; S.R.: research supervision; manuscript write-up; A.G.: conceptualization; methodology; partly involved in data collection and analysis for training and validation; visualization; research supervision, manuscript write-up, manuscript editing. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the cantonal Ethics Committee of Zurich, Switzerland, University of Zurich (BASEC Nr.: Req-2018-00440, 14th of June 2018).

**Informed Consent Statement:** Written informed consent has been obtained from the participants for the interviews and to publish the study.

**Data Availability Statement:** Data are stored at the Institute of Biomedical Ethics and medical History, University of Zurich.

**Acknowledgments:** The authors would like to thank all participants for their support and contribution to this study. Without their voluntary participation and openness to discuss personal experiences and opinions it would not have been possible to achieve these results. We also thank our colleague David Stamm for proofreading the manuscript.

**Conflicts of Interest:** The authors declare no conflict of interest.
