Assessing patient-reported outcomes, pharmacist interventions and medication adherence in Multiple Sclerosis
1 Study Details
1.1 Background
Patient reported outcomes (PROs), defined as a measurement of any aspect of a patient’s health status that comes directly from the patient, are an effective took for understanding patient insights into their disease management, quality of life and functioning and can help inform clinical decision making and improve quality of care. VSP’s current workflow captures specific PROs during monthly refill assessments and alerts the pharmacist of any negative findings. An integrated clinic pharmacist then performs a variety of interventions to facilitate medication adherence and identify medication safety or effectiveness or further coordination of care.
1.2 Objectives
Quantify patient-reported response to therapy
Quantify number and type of pharmacist interventions performed during monthly refill assessments.
1.3 Inclusion Criteria
Patients must have at least 2 medications fills through VSP
Patients must have at least 2 MRQ responses
Medication fills must have occurred between January and March 2020 `
Medication must be prescribed by a VUMC multiple sclerosis clinic provider
2 Descriptive statistics
2.1 Demographics and patient characteristics
There are 335 unique patients that completed 1017 MRQs.
Baseline Descriptive Statistics, Diagnosis, and Medication. | |
N=335 |
|
---|---|
Age | 45.0 52.3 59.9 |
Gender | |
  Female | 0.76 (256) |
  Male | 0.24 ( 79) |
Race | |
  White | 0.82 (274) |
  Black or African American | 0.15 ( 50) |
  American Indian or Alaska Native | 0.00 ( 1) |
  Other Asian | 0.00 ( 1) |
  Unknown | 0.03 ( 9) |
Ethnicity | |
  Not Hispanic, Latino/a, or Spanish origin | 0.95 (319) |
  Unknown | 0.04 ( 12) |
  Other Hispanic, Latino/a, or Spanish origin | 0.01 ( 4) |
Insurance Type | |
  Commercial | 0.59 (196) |
  Medicare | 0.38 (127) |
  Medicaid | 0.04 ( 12) |
Speciality Med | |
  Ampyra/XR (dalfampridine) | 0.10 (33) |
  Aubagio (teriflunomide) | 0.10 (32) |
  Gilenya (fingolimod) | 0.22 (74) |
  glatiramer acetate | 0.17 (56) |
  interferon beta-1a | 0.17 (56) |
  interferon beta-1b | 0.04 (13) |
  Mayzent (siponimod) | 0.00 ( 1) |
  Plegridy (peginterferon beta-1a) | 0.02 ( 7) |
  Tecfidera (dimethyl fumarate) | 0.19 (63) |
MS Indication | |
  Relapsing-remitting | 0.88 (295) |
  Primary progressive | 0.03 ( 11) |
  Secondary progressive | 0.08 ( 27) |
  Tumefactive | 0.00 ( 1) |
  Clinically isolated syndrome | 0.00 ( 1) |
a b c represent the lower quartile a, the median b, and the upper quartile c for continuous variables. Numbers after proportions are frequencies. |
2.1.1 Specialty medication by Indication
Relapsing-remitting | Primary progressive | Secondary progressive | Tumefactive | Clinically isolated syndrome | |
---|---|---|---|---|---|
Ampyra/XR (dalfampridine) | 13 | 8 | 12 | 0 | 0 |
Aubagio (teriflunomide) | 27 | 0 | 4 | 1 | 0 |
Gilenya (fingolimod) | 71 | 1 | 2 | 0 | 0 |
glatiramer acetate | 53 | 0 | 3 | 0 | 0 |
interferon beta-1a | 54 | 0 | 1 | 0 | 1 |
interferon beta-1b | 12 | 0 | 1 | 0 | 0 |
Mayzent (siponimod) | 0 | 1 | 0 | 0 | 0 |
Plegridy (peginterferon beta-1a) | 7 | 0 | 0 | 0 | 0 |
Tecfidera (dimethyl fumarate) | 58 | 1 | 4 | 0 | 0 |
3 MRQ
3.1 Count of MRQs per patient
3.2 Missed doses
3.2.1 Missed Doses Per Patient
Descriptive Statistics (N=335). | |
N=335 |
|
---|---|
Number of Missed Doses | |
  0 | 0.90 (301) |
  1 | 0.09 ( 31) |
  2 | 0.01 ( 3) |
Numbers after proportions are frequencies. |
3.2.2 Missed Doses in the last month per MRQ
Missed doses in the last month per MRQ. | |
N=1017 |
|
---|---|
num_missed_doses | |
  1-2 doses | 0.02 ( 25) |
  3-4 doses | 0.01 ( 7) |
  5 or more doses | 0.00 ( 5) |
  NA | 0.96 (980) |
Numbers after proportions are frequencies. |
3.2.3 Reasons for missed doses
The checkbox variables were combined into one in the box data.
Reasons | Frequency |
---|---|
Forgetfulness | 22 |
Ran Out of Medication | 6 |
Other | 3 |
Intolerance / Side Effects | 2 |
Purposefully Held Due to Illness or Procedure | 2 |
Financial Barrier | 1 |
Medication Remaining, but Unavailable (i.e. left at home when traveling) | 1 |
Patient was in Hospital | 1 |
Pending Labwork | 1 |
3.3 Patient perceived efficacy
3.3.1 Table
Patient reported medication effictiveness. | |
N=1017 |
|
---|---|
Effectiveness | |
  Poor | 0.00 ( 1) |
  Fair | 0.02 ( 17) |
  Good | 0.66 (668) |
  Excellent | 0.33 (331) |
Numbers after proportions are frequencies. |
3.3.2 Visualization
3.4 Adverse effects
3.4.1 Count of adverse effects
Adverse effects by MRQ. | |
N=1017 |
|
---|---|
adverse_effects | |
  No | 0.99 (1011) |
  Yes | 0.01 ( 6) |
Numbers after proportions are frequencies. |
3.4.2 Side effect details
Side Effect Details |
---|
flu-like symptoms - mild/moderate |
Patient stated when taking the medication it feels like her face has a burning sensation |
Hair loss. Provider aware. Patient will continue to take medication. No follow up needed. |
flushing |
patient has had a headache for approx. 1 week, she stated that she was going to reach out to her doctor and discuss |
Dermatitis- she will be going to the doctor about the condition next week |
4 Pharmacist Interventions
4.1 Number of Interventions per Patient
4.2 Types of Interventions
Interventions | Frequency |
---|---|
Adherence/Missed Dose | 39 |
Therapeutic Monitoring - Safety | 36 |
Common Side Effect/Toxicity | 20 |
Other | 15 |
Condition-Related Concern or Exacerbation | 13 |
Coordination of Care | 11 |
Financial/Insurance Issue | 9 |
Medication List Change | 8 |
ED/Hospitalization/Urgent Care Visit | 6 |
New Condition or Diagnosis Identified | 6 |
Medication Interaction | 5 |
Adverse Event | 2 |
Drug Administration Question | 2 |
Drug Stability and Storage Question | 2 |
Drug Dosing Question | 1 |
4.3 Outcomes of Interventions
Interventions | Frequency |
---|---|
Identified Issue Resolved | 127 |
Identified Issue Unresolved | 4 |
Recommendation to Provider Accepted | 3 |
Dosage Adjustment Made | 2 |
Follow-Up Care Scheduled (Lab/Appointment) | 2 |
Alternative Therapy Started | 1 |