Measuring Adherence and Outcomes in the Treatment of Patients With Multiple Sclerosis

Both adherence and outcomes are more difficult to measure in patients with multiple sclerosis (MS) than in patients with diseases such as hypertension, for which most medications are taken orally and surrogate outcomes (eg, blood pressure) are routinely collected. To characterize the adherence and o...

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Bibliographic Details
Published in:Journal of Osteopathic Medicine (Online) 2017-12, Vol.117 (12), p.737-747
Main Authors: Hao, Jing, Pitcavage, James, Jones, J.B., Hoegerl, Carl, Graham, Jove
Format: Article
Language:English
Subjects:
Adult
Cost control
Emergency Service, Hospital - statistics & numerical data
Female
Health Care Costs
health care outcomes
Health Resources - statistics & numerical data
Health services utilization
Hospitalization - economics
Hospitalization - statistics & numerical data
Humans
Male
medication adherence
Medication Adherence - statistics & numerical data
Middle Aged
Multiple sclerosis
Multiple Sclerosis - drug therapy
Prospective Studies
Retrospective Studies
Surveys and Questionnaires
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Summary:Both adherence and outcomes are more difficult to measure in patients with multiple sclerosis (MS) than in patients with diseases such as hypertension, for which most medications are taken orally and surrogate outcomes (eg, blood pressure) are routinely collected. To characterize the adherence and outcomes of patients with MS within a large integrated health system and to assess the relationship between adherence and outcomes. Retrospective review of adherence and health care utilization outcomes via electronic health records and claims (2004-2013) combined with a prospective survey regarding adherence and functional outcomes (2012-2013). Retrospectively, medication possession ratios were calculated, and adherence groups were compared regarding health care utilization and costs. Prospectively, patients were recruited to complete questionnaires to measure self-reported adherence (SRA) and MS-specific outcomes, including the Multiple Sclerosis Impact Scale (MSIS), the Kurtzke Expanded Disability Status Scale (EDSS), and the Treatment Satisfaction Questionnaire for Medication (TSQM). Regression was used to statistically test for differences in these outcomes among adherence groups. A total of 681 patients were studied. Most patients (307 of 375 [82%] in the retrospective cohort and 244 of 306 [89%] in the prospective cohort) had greater that 80% adherence to their MS medications. Mean inpatient days per patient for MS-related admissions was highest for high-adherence than for intermediate and low-adherence patients (0.52 vs 0.23 and 0.34, respectively; P
ISSN:2702-3648
2702-3648
1945-1997
DOI:10.7556/jaoa.2017.145