Elizabeth S Gromisch1, Aaron P Turner2, Steven L Leipertz3, John Beauvais4, Jodie K Haselkorn5. 1. Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, Connecticut; Psychology Service, VA Connecticut Healthcare System, West Haven, Connecticut; Department of Neurology, University of Connecticut School of Medicine, Farmington, Connecticut; Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut; Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, Connecticut. Electronic address: elizabeth.gromisch@trinityhealthofne.org. 2. Multiple Sclerosis Center of Excellence West, Veterans Affairs, Seattle, Washington; Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington. 3. Multiple Sclerosis Center of Excellence West, Veterans Affairs, Seattle, Washington. 4. Psychology Service, VA Connecticut Healthcare System, West Haven, Connecticut; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut. 5. Multiple Sclerosis Center of Excellence West, Veterans Affairs, Seattle, Washington; Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, Washington; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington.
Abstract
OBJECTIVE: To determine which factors are associated with suboptimal disease-modifying therapy (DMT) adherence and to develop an explanatory model that could be used to identify individuals at risk and potentially inform interventions. DESIGN: Cross-sectional cohort study using electronic health records. SETTING: Veterans Health Administration (VA). PARTICIPANTS: Veterans with multiple sclerosis (MS) (N=2939; 79.69% men) who received care through the VA and were included in the VA MS Center of Excellence Data Repository. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Suboptimal DMT adherence (<80%), demographics, co-occurring conditions, and health care use. RESULTS: Nearly 31% of participants had suboptimal adherence. Flags for suboptimal adherence included >20% missed appointments (odds ratio [OR], 3.78; 95% CI, 2.45-2.82), traumatic brain injuries (OR, 1.55; 95% CI, 1.12-2.14), age younger than 59 years (OR, 1.47; 95% CI, 1.23-1.74), ≥1 emergency department visits (OR, 1.40; 95% CI, 1.18-1.67), mood disorders (ie, depressive and bipolar disorders) (OR, 1.40; 95% CI, 1.18-1.66), and service connection (OR, 1.22; 95% CI, 1.01-1.47). Hyperlipidemia (OR, 0.77; 95% CI, 0.65-0.92) and being issued a wheelchair (OR, 0.83; 95% CI, 0.70-1.00) were associated with lower risk. CONCLUSIONS: Suboptimal adherence to DMTs continues to be an issue. Interventions that focus on person-level barriers should be urgently explored to increase adherence and improve self-management abilities. Published by Elsevier Inc.
OBJECTIVE: To determine which factors are associated with suboptimal disease-modifying therapy (DMT) adherence and to develop an explanatory model that could be used to identify individuals at risk and potentially inform interventions. DESIGN: Cross-sectional cohort study using electronic health records. SETTING: Veterans Health Administration (VA). PARTICIPANTS: Veterans with multiple sclerosis (MS) (N=2939; 79.69% men) who received care through the VA and were included in the VA MS Center of Excellence Data Repository. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Suboptimal DMT adherence (<80%), demographics, co-occurring conditions, and health care use. RESULTS: Nearly 31% of participants had suboptimal adherence. Flags for suboptimal adherence included >20% missed appointments (odds ratio [OR], 3.78; 95% CI, 2.45-2.82), traumatic brain injuries (OR, 1.55; 95% CI, 1.12-2.14), age younger than 59 years (OR, 1.47; 95% CI, 1.23-1.74), ≥1 emergency department visits (OR, 1.40; 95% CI, 1.18-1.67), mood disorders (ie, depressive and bipolar disorders) (OR, 1.40; 95% CI, 1.18-1.66), and service connection (OR, 1.22; 95% CI, 1.01-1.47). Hyperlipidemia (OR, 0.77; 95% CI, 0.65-0.92) and being issued a wheelchair (OR, 0.83; 95% CI, 0.70-1.00) were associated with lower risk. CONCLUSIONS: Suboptimal adherence to DMTs continues to be an issue. Interventions that focus on person-level barriers should be urgently explored to increase adherence and improve self-management abilities. Published by Elsevier Inc.
Entities:
Keywords:
Appointments and schedules; Electronic health records; Medication adherence; Multiple sclerosis; Rehabilitation; Risk factors
Authors: Gisela Zanga; Estefania Drzewiscki; Paula Tagliani; Maximiliano Smietniansky; Maria M Esnaola Y Rojas; Diego Caruso Journal: Ther Adv Neurol Disord Date: 2021-10-05 Impact factor: 6.570