Department of Psychology, University of Missouri - Kansas City, Kansas City, MO, USA.
Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA.
J Behav Med. 2018 Apr;41(2):253-260. doi: 10.1007/s10865-017-9900-9. Epub 2017 Nov 9.
Patients with multiple sclerosis (MS) are often nonadherent to their disease modifying therapy (DMT). While recent studies demonstrate enhanced DMT adherence following intervention grounded in motivational interviewing (MI), little is known about how to address DMT reinitiation among MS patients who have prematurely discontinued DMT against medical advice and do not intend to reinitiate. We examined baseline predictors of DMT reinitiation among patients with MS who discontinued medications against medical advice following a telephone-based MI and Cognitive Behavioral Therapy (MI-CBT) intervention. Following MI-CBT intervention, 66 patients reported whether or not they opted to reinitiate DMT. Rate of disease progression (β = 0.295) and perceived personal control (β = - 0.131) emerged as unique significant predictors of DMT reinitiation following intervention. Clinical characteristics and health-related beliefs may be used to prospectively identify patients most likely to reinitiate DMT following MI-CBT intervention, furthering the goal of preserving brain health and preventing neurologic decline in MS via appropriate DMT utilization. Further study is warranted to delineate potential mediators and moderators of DMT reinitiation outcomes.
多发性硬化症 (MS) 患者常常不遵医嘱服用疾病修正疗法 (DMT)。尽管最近的研究表明,在基于动机性访谈 (MI) 的干预措施之后,DMT 的遵医嘱率会有所提高,但对于那些未经医嘱就提前停止 DMT 且不打算重新开始的 MS 患者,如何重新开始 DMT 知之甚少。我们研究了在接受电话 MI 和认知行为疗法 (MI-CBT) 干预后,未经医嘱停止药物治疗的 MS 患者重新开始 DMT 的基线预测因素。在 MI-CBT 干预后,66 名患者报告了他们是否选择重新开始 DMT。疾病进展速度 (β=0.295) 和感知个人控制 (β=-0.131) 是干预后重新开始 DMT 的唯一显著预测因素。临床特征和与健康相关的信念可以用于前瞻性地识别最有可能在 MI-CBT 干预后重新开始 DMT 的患者,从而通过适当的 DMT 利用来保护大脑健康并预防 MS 的神经功能下降。需要进一步的研究来阐明 DMT 重新开始结果的潜在中介因素和调节因素。