Patient Preference and Adherence (Jun 2024)
Personalized Intervention to Improve Medication Adherence for Persons with Multiple Sclerosis
Abstract
Efrat Neter,1 Efrat Esterkin-Hubner,2 Lea Glass-Marmor,2 Anat Wolkowitz,2 Idit Lavi3 ,† Ariel Miller2,4 1Ruppin Academic Center, Emeq Hefer, Israel; 2Multiple Sclerosis Center & Department of Neurology,Carmel Medical Center, Haifa, Israel; 3Department of Community Medicine & Epidemiology, Carmel Medical Center, Haifa, Israel; 4Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel†Idit Lavi passed away on 31.7.2022Correspondence: Efrat Neter, Ruppin Academic Center, 3 Bait, Emeq Hefer, 4025000, Israel, Tel +972-54-6462677, Fax +972-9-8983043, Email [email protected]; [email protected]: To evaluate the acceptability, retention, and efficacy of face-to-face intervention, incorporating education and Motivational Interviewing (MI) to support persons with relapsing-remitting multiple sclerosis (PwRRMS) and increase self-reported medication adherence.Patients and Methods: PwRRMS (N = 60) prescribed Disease Modifying Treatment (DMT), who were identified as non-adherent and consented to participate in an intervention, received verbal education and counseling from their treating physician, a tailored MI counseling and a booster session via telephone with a health psychologist, and a concluding MI counseling six months later. Each PwRRMS filled a battery of patient-reported outcomes (PROs) at baseline, six and 12 months later. The design was a quasi-experimental pre-test post-test across a year.Results: Of the sixty identified persons who consented to enroll, 52 completed the intervention and 46 completed the follow-up. At six months following the baseline, adherence scores increased (median = 12.0) and were significantly different than at baseline (median=10.0, p = 0.030). Still, at 12 months follow-up there was no significant difference from baseline in reported adherence (median = 11.0, p = 0.106).Conclusion: This study demonstrated reasonable retention and initial efficacy of a combined psycho-education and MI protocol for PwRRMS to enhance medication adherence to DMT. To maintain the change, a more sustained intervention is required.Plain Language Summary: The study focused on persons with relapsing-remitting multiple sclerosis (PwRRMS) who do not adhere to their prescribed medication.Following the identification of non-adherent persons, PwRRMS were offered an intervention to increase their adherence. The study examined how many of those identified consented to enroll in the intervention, how many remained in the intervention, and whether the intervention was efficacious in terms of self-reported adherence.The intervention included verbal education and counseling from the treating physician, immediately followed by tailored counseling by a psychologist. There was a booster session via telephone with the psychologist, and a concluding counseling meeting six months later. Participants were followed for a year after the initial counseling.Two-thirds of PWMS identified as non-adherent consented to enroll (n = 60), 52 completed the intervention and 46 completed the follow-up. At six months following counseling, self-reported adherence scores significantly increased, but at 12 months follow-up there was no significant difference from baseline in reported adherence. To maintain the change, a more sustained intervention is required.Keywords: disease modifying therapy, medication adherence, medication beliefs, motivational interviewing, multiple sclerosis, participatory medicine, patient reported outcomes
