Integrated Practice Model Can Improve Adherence to Multiple Sclerosis Therapies

Integrated clinical and specialty pharmacy practice model includes an interdisciplinary team of physicians, nurses, and pharmacists.

Use of an integrated approach to care can improve patient compliance with multiple sclerosis (MS) therapies, according to a pharmacy practice model published in theMarch 15, 2014 issue of the American Journal of Health-System Pharmacy.

Developed by a team of researchers at the University of Illinois Hospital and Health Sciences System (UI Health), the model seeks to address patient compliance with disease-modifying therapies (DMTs) that are used to treat MS, which are often costly and require special administration, handling, and storage. The treatment is also associated with a high rate of nonadherence and additional safety risks.

“Management of DMTs can be challenging because of the specialized training and monitoring requirements, the debilitating nature of MS, and the high rates of patient nonadherence,” the authors write. “Some authors have reported that nonadherence rates are notably higher with DMTs compared with other long-term medications.”

Various studies have placed DMT adherence rates among patients with MS at anywhere from 41% to 88%.

“Poor adherence may be attributable to a lack of observable effect on symptoms, the severity of the disease, insufficient knowledge about the disease, insufficient social support, unrealistic expectations regarding therapy benefits, the need for frequent and lifelong injections, a fear of injections, and troublesome adverse effects,” the authors note.

Beyond the challenge of adherence, health care providers must also coordinate with multiple entities outside the health system, which places a time burden on staff resulting in inconsistencies with electronic medical record documentation, delayed initiation of treatment, and increased turnaround time for training, according to the authors. To address these challenges, UI Health developed an interdisciplinary practice that involves doctors, a registered nurse, and a clinical pharmacist.

“When a patient is diagnosed with MS in the hospital or an outpatient clinic, the attending neurologist forwards a notification to the clinical pharmacist, who reviews the patient’s profile thoroughly and assesses the training and educational needs of the patient and family,” the authors write. “The clinical pharmacist, in collaboration with the registered nurse, also assists with coordinating therapy initiation and ongoing DMT management. In addition, the clinical pharmacist provides face-to-face clinic services along with the attending neurologist for one half-day per week to evaluate patients’ response, tolerance, and compliance with the selected therapy.”

Vital components of the integrated model also include targeted assessments, and medication and disease education before DMT initiation and throughout therapy.

Since establishing the integrated model in 2010, UI reports an adherence rate above their service goal of 90%, with additional long-term studies planned to address the program’s effect on the clinical outcome for patients.

“This practice model has increasing importance to health systems and accountable care organizations,” the authors write. “As they assume more risk for patient outcomes, it allows for greater control over the care of patients treated with these medications and greater control over the coordination of care for patients treated with specialty medications within the patient’s medical home. Through this new practice model, providers are empowered to incorporate specialty medication management into transitions in care, admission and discharge quality indicators, readmissions, and other core measures.”