ClinicSpeak: perceptions on adherence to treatment

Adherence another disconnect between neurologists and MSers? #ClinicSpeak #MSBlog #MSResearch

"Since my recent post on adherence I am beginning to realise how important this subject is and how relatively under studied it is in the MS space. Why? The survey below of Belgium neurologists indicates that at least to them it is important. Interestingly the survey simply asks them their perception about adherence amongst their patients; the majority perceived it as being good or excellent. Is this another example of a disconnect between physician perception and reality? Numerous studies have shown that what physicians perceive they do in clinical practice is a long way away from what they actually do in reality. Let's hope this survey is followed up with a MSer study to actually measure adherence in real life; I suspect it will be much lower than expected. For example with injectables the average MSers misses numerous injections per month. I am sure the story will be similar with the orals."

"We had a meeting on Thursday to discuss adherence and what can be done about it. We decided to scope the problem and to see how big a problem it is in MS and then to design some interventions to improve adherence. There is no point in promoting treat-2-target of NEDA if MSers are not taking their DMTs as prescribed. I am also interested in studying adherence to lifestyle interventions; for example, how can we increase uptake and adherence to exercise programmes and regular vitamin D supplementation? Any ideas would be welcome. Is this an issue simply about education? Or is there a technology solution? Or is it simply being driven by cognitive problems? We know that MSers who have cognitive impairment or more likely to have poor adherence to treatments compared to those who are cognitively intact. If cognitive impairment is one of the main drivers we may need to factor in early access to treatment, to prevent or delay cognitive problems, as one of the solutions to tackling poor adherence."

"Please note our adherence survey is still open."

Decoo & Vokaer. Treatment adherence in multiple sclerosis: a survey of Belgian neurologists. Patient Prefer Adherence. 2015 Nov 19;9:1669-1676.

BACKGROUND: Poor treatment adherence is common among patients with multiple sclerosis (MS). This survey evaluated neurologists' perception of treatment adherence among MS patients.

MATERIALS AND METHODS: This questionnaire-based survey of Belgian neurologists treating MS patients was conducted between June and July 2014. Face-to-face interviews with the neurologists were based on a semistructured questionnaire containing questions regarding the perception of the treatment-adherence level.

RESULTS: A total of 41 neurologists participated in the survey. Of these, 88% indicated frequent discussions about treatment adherence as beneficial for treatment efficacy. The mean time spent on the treatment-adherence discussion during the initial consultation was 11 minutes, with 24% of doctors spending 5 minutes and 24% of doctors spending 10 minutes discussing this issue. The majority of neurologists (56%) perceived the adherence level in MS as good, and 12% perceived it as excellent. The majority of neurologists (64%) indicated intolerance as a main cause of poor adherence, and all neurologists reported insufficient efficacy as a consequence of nonadherence. The importance of adherence in the neurologists' practice was evaluated on a scale of 1-10, with 1= "not very important" and 10= "very important": 44% of doctors indicated a score of 10, and the mean score was 9.0.

CONCLUSION: Belgian neurologists consider treatment adherence in MS as essential for the benefits of therapies. However, although neurologists are aware of the consequences of nonadherence, they generally spend limited time discussing the importance of treatment adherence with their patients.

CoI: multiple

Labels: , ,