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Treatment adherence and unmet needs at hospital pharmacy for the care of Spanish patients with multiple sclerosis
  1. Emilio Monte-Boquet1,
  2. Laura Lorente-Fernández1,
  3. Ignacio Cardona-Pascual2,
  4. Miguel Ángel Conesa-Muñoz3,
  5. María Fernández-Pacheco4,
  6. Javier García-Fernández5,
  7. Ana García-Monsalve6,
  8. María Olatz Ibarra-Barrueta7,
  9. Aitziber Illaro-Uranga8,
  10. Luís Margusino-Framiñán9,
  11. Jesús Mayorga-Pérez8,
  12. Isabel Moya-Carmona10,
  13. Paula Pérez-Puente11,
  14. María Ángeles Porta-Sánchez9,
  15. Inmaculada Ramírez-Alapont12,
  16. Patricia Sanmartín-Fenollera13,
  17. Elena Victoria Tortajada-Esteban14,
  18. José Ramón Vizoso-Hermida9,
  19. Sheila Mora-García15,
  20. on behalf of the EMHOPHAR Study Group
  1. 1Department of Pharmacy, Hospital Universitario y Politécnico La Fe, Valencia, Spain
  2. 2Hospital Vall d'Hebron, Barcelona, Spain
  3. 3Hospital Carlos Haya, Málaga, Spain
  4. 4Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
  5. 5C.M. de Ourense, Ourense, Spain
  6. 6Hospital Vega Baja, Orihuela, Alicante, Spain
  7. 7Hospital Galdakao—Usansolo, Galdakao, Spain
  8. 8Hospital Universitario Marqués de Valdecilla, Santander, Spain
  9. 9CHUAC, A Coruña, Spain
  10. 10Hospital Virgen de la Victoria, Málaga, Spain
  11. 11Hospital San Pedro de Alcántara, Cáceres, Spain
  12. 12Hospital Clínico Universitario de Valencia, Valencia, Spain
  13. 13Hospital Universitario de Alcorcón, Madrid, Spain
  14. 14Fundación Jiménez Díaz, Madrid, Spain
  15. 15Medical Department, Novartis Farmáceutica, S.A., Barcelona, Spain
  1. Correspondence to Dr Emilio Monte Boquet, Department of Pharmacy, Hospital Universitario y Politécnico La Fe, Bulevar Sur s/n, Valencia 46026, Spain; monte_emi{at}gva.es

Abstract

Objective To assess unmet needs at hospital pharmacies and treatment adherence of patients with multiple sclerosis (MS) treated with disease-modifying therapies (DMTs).

Methods A non-interventional and multicentre study involving 24 pharmacies that included 237 patients with relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS) treated with DMTs. Pharmacists completed a questionnaire on management and needs. Adherence was assessed using the Morisky-Green test.

Results The mean age of patients was 40.1±9.4 years (65.8% women). The average time from diagnosis was 7.5±5.6 years, 95.4% had RRMS and 61.2% had no relapses during the last year. Most patients (62.4%) had Expanded Disability Status Scale grade 0–2.5. Overall adherence was 77.1%. Treatment adherence was significantly higher among patients with no relapses (82.9% vs 67.4%, p<0.05) and among those ≥40 years old (85.1% vs 68.3%, p<0.05). 21.1% of pharmacies did not have adequate educational materials and in 16% of cases there was no proper space to assure confidentiality. A specific protocol to monitor adverse events only existed in 21% of pharmacies and to monitor adherence in 32%. Major unmet needs for pharmacists were educational materials, adherence training, staff shortages and increased workload. There was a trend towards lower adherence at hospitals with a higher workload (68.6% vs 80.2%) and with a lack of educational materials (75.2% vs 84.6%). In 19.8% of cases there was a discrepancy between pharmacist perception of adherence and the Morisky-Green test.

Conclusions It is necessary to improve educational materials and operational protocols regarding workload at hospital pharmacies to provide adequate follow-up and to ensure adherence by Spanish patients with MS.

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