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.
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.
Arch Phys Med Rehabil. 2020 May;101(5):807-814. doi: 10.1016/j.apmr.2019.11.005. Epub 2019 Dec 3.
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.
Cross-sectional cohort study using electronic health records.
Veterans Health Administration (VA).
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.
Not applicable.
Suboptimal DMT adherence (<80%), demographics, co-occurring conditions, and health care use.
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.
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.
确定哪些因素与疾病修正治疗（DMT）依从性不理想相关，并建立一个解释模型，以识别有风险的个体，并可能为干预措施提供信息。
使用电子健康记录的横断面队列研究。
退伍军人事务部（VA）。
接受 VA 医疗服务并被纳入 VA 多发性硬化症卓越中心数据存储库的 2939 名多发性硬化症（MS）退伍军人（79.69%为男性）。
不适用。
DMT 依从性不理想（<80%）、人口统计学、共病和医疗保健使用情况。
近 31%的参与者依从性不理想。依从性不理想的标志包括：错过预约>20%（比值比[OR]，3.78；95%置信区间[CI]，2.45-2.82）、创伤性脑损伤（OR，1.55；95%CI，1.12-2.14）、年龄<59 岁（OR，1.47；95%CI，1.23-1.74）、≥1 次急诊就诊（OR，1.40；95%CI，1.18-1.67）、心境障碍（即抑郁和双相情感障碍）（OR，1.40；95%CI，1.18-1.66）和服务连接（OR，1.22；95%CI，1.01-1.47）。高血脂症（OR，0.77；95%CI，0.65-0.92）和发放轮椅（OR，0.83；95%CI，0.70-1.00）与较低的风险相关。
DMT 依从性不理想仍然是一个问题。应紧急探索以个人为中心的障碍为重点的干预措施，以提高依从性并改善自我管理能力。
