Treatment adherence and unmet needs at hospital pharmacy for the care of Spanish patients with multiple sclerosis
- Emilio Monte-Boquet1,
- Laura Lorente-Fernández1,
- Ignacio Cardona-Pascual2,
- Miguel Ángel Conesa-Muñoz3,
- María Fernández-Pacheco4,
- Javier García-Fernández5,
- Ana García-Monsalve6,
- María Olatz Ibarra-Barrueta7,
- Aitziber Illaro-Uranga8,
- Luís Margusino-Framiñán9,
- Jesús Mayorga-Pérez8,
- Isabel Moya-Carmona10,
- Paula Pérez-Puente11,
- María Ángeles Porta-Sánchez9,
- Inmaculada Ramírez-Alapont12,
- Patricia Sanmartín-Fenollera13,
- Elena Victoria Tortajada-Esteban14,
- José Ramón Vizoso-Hermida9,
- Sheila Mora-García15,
- on behalf of the EMHOPHAR Study Group
- 1Department of Pharmacy, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- 2Hospital Vall d'Hebron, Barcelona, Spain
- 3Hospital Carlos Haya, Málaga, Spain
- 4Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
- 5C.M. de Ourense, Ourense, Spain
- 6Hospital Vega Baja, Orihuela, Alicante, Spain
- 7Hospital Galdakao—Usansolo, Galdakao, Spain
- 8Hospital Universitario Marqués de Valdecilla, Santander, Spain
- 9CHUAC, A Coruña, Spain
- 10Hospital Virgen de la Victoria, Málaga, Spain
- 11Hospital San Pedro de Alcántara, Cáceres, Spain
- 12Hospital Clínico Universitario de Valencia, Valencia, Spain
- 13Hospital Universitario de Alcorcón, Madrid, Spain
- 14Fundación Jiménez Díaz, Madrid, Spain
- 15Medical Department, Novartis Farmáceutica, S.A., Barcelona, Spain
- 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
- Received 13 July 2012
- Accepted 17 September 2012
- Published Online First 30 October 2012
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.
