b'VA Seeks Increase in Medication Adherence Among Veterans With MSNearly One-Third of Patients Didnt Closely Follow Treatment RegimensBy Stephen SpotswoodA recent VA study found that 31% of MS patients in the VAfor nonadherence among the 2,939 vet-system had suboptimal medication adherence. That canerans studied included missed appoint-ments, traumatic brain injury and mood especially be an issue for relapsing forms of the disease,disorders,amongothers.Thestudy concludedthatperson-specificinter-which affect 85% of MS patients, because there could beventions are sorely needed for VAs MS times of partial or complete remission when symptomspatient population. 1The researchers suggested that patients are reduced or absent. Researchers noted that recentexperiencedbarrierspreventingthem from adhering strictly to a disease modi-exacerbations tended to increase adherence, althoughfying therapy. Depression and anxietyfailing to regularly use disease-modifying treatment has beenbothcommoninMSpatientscan cause medication lapses. Treating those associated with more relapses and exacerbations, a greaterconditions has been found to improve adherence. Side effects can be a barrier likelihood of disease progression and a poorer quality of life.early in the course of a DMT and can contributetopooradherenceoreven discontinuation of treatment.One particularly troublesome barrier is that the benefits of a medication might WEST HAVEN, CTJust as there arepatientswhofailtoadheretotreat- notbeimmediatelyapparent,causing manypresentationsofmultiplescle- ment have more disability and a greaterpatients to underestimate its use.rosis with myriad symptoms, patientsimpact of the disease on their lives, butADMTsbenefitsarenotalways have a range of reasons for failing tohealthcaresystemsalsobearhigherimmediately apparent, the researchers adhere to their treatment plans. costsrelatedtoincreasedemergencyexplained. They reduce the likelihood Thedegenerativenatureofthedis- care and hospital visits. of a bad thing happening in the future easemakesmedicationnonadherenceA VA study published recently in thebutprovidelittleimmediateandtan-particularlyproblematic,andVAisArchivesofPhysicalMedicineandgible benefit. As a result, patient per-engaged in a number of ways to helpRehabilitation looking at MS patientsceptions of effectiveness are associated patientsstickascloseaspossibletoin the VA system found that 31% hadwithadherence.Peopletakemedica-their regimen. suboptimalmedicationadherence.Ations when they think they are helpful Poorer adherence to an MS treatmentteam led by VA Connecticut Healthcareand dont when they do not.regimen has been associated with moreSystem, West Haven, researchers deter- Somewhat paradoxically, the presence relapsesandexacerbations,agreatermined that fewer than 70% refilled theirof recent exacerbations were associated likelihoodofdiseaseprogressionandmedications at least 80% of the timewith better adherence. The researchers apoorerqualityoflife.Notonlydoover a two-year span. The risk factorshypothesize that the exacerbations act Continued on Page 24 u22 2020 COMPENDIUM OF FEDERAL MEDICINE'