Medication adherence in multiple sclerosis: a model for other chronic diseases?
Our previous work has shown that adherence to the disease-modifying therapies (DMTs) for multiple sclerosis (MS) is higher than what has been reported in other chronic diseases. Our hypothesis is that the specialized management provided to patients prescribed DMTs, which includes support from drug nurses, produces higher adherence. As such, our ultimate goal is to investigate if the management of MS can be used as a model for improving adherence in other chronic conditions. However, the first step in meeting this larger goal is to confirm and extend our initial findings by comparing adherence in MS to other comparable diseases using equivalent methods and population-based samples. Second, to further test our hypothesis that it is the specialized management of DMTs, and not patient or disease-specific factors impacting adherence, we will compare adherence to DMT and non-DMT medications within individuals with MS.
Objective 1. Compare medication adherence to DMTs in MS with other chronic conditions using population-based cohorts (between cohort comparisons).
Hypothesis: Adherence will be higher in MS than other chronic diseases (rheumatoid arthritis, epilepsy, Parkinson disease). Sociodemographic factors will not be consistently associated with adherence.
Objective 2. Compare adherence to DMTs with chronic non-DMT medications in the MS cohort (within subject comparison).
Hypothesis: Adherence will be lower for non-DMT medications (statins, antihypertensives, and thyroid replacement) than for the DMTs. That is, higher adherence in MS is drug (i.e. management of the drug) specific, and not influenced by patient or disease factors.
Outcomes are the same for both study objectives:
Optimal adherence to drug therapy after the first year. The first year was chosen as it is known to be a high risk period for non-adherence.
Optimal adherence to drug therapy at yearly intervals (up to 5 years)
Discontinuation of drug therapy (i.e. no further dispensations): a) after the first dispensation, and b) within the first year.