b'VA Seeks Increase in Medication Adherence Among Veterans With MSu From Page 22as a reminder to the patient of the dan- in-person counseling was used to help re-gers of the disease and cause them tomind patients of their own perceptions of adhere more strongly to their treatment.the benefits of medication. This was com-Forpatientswithrelapsingformsofbined with telephone support. The com-MS,whichistheinitialdiagnosisforbination was found to increase adherence about 85% of patients, relapses or exac- over time. This intervention was consid-erbationsclearly defined attacks of newered particularly useful, since the inter-orincreasingneurologicsymptomsareventions were brief, could be delivered to followed by periods of partial or com- a veteran anywhere over the phone and pleteremission.Duringremissions,allcould be tailored to the individual patient.symptomsmightdisappear,whichcanAnotherVAstudyexaminedwhat exacerbate problems with adherence. Onformsofscreeningcouldbeusedto the other hand, analysis of some studiesidentify patients who would have dif-for oral medications has indicated theyficultiesadheringtoMSmedications. can significantly reduce risk of relapse,The best predictor for adherence was a although no treatment eliminates it. single, simple question: How confident There also is a patients general pat- are you that you will be taking your pre-tern of self-care to consider when tally- scribed DMT one month from now?ing treatment barriers. Patients who areMostofVAsinterventionsseeking morelikelytomissmedicalappoint- toimproveadherencearesimilarly mentsingeneralwerefoundtoalsosimple. They include regular reminders have more nonadherence, according tofromnursesandpharmacystaff. The the report. integrated VA system, which allows all Andthetypeandquantityoftheproviders to see if and when a patient drugs themselves can provide barriers.refills their medication, makes it clear Medicationsthatrequiremoredoseswhenapatientmightnotbeadher-wereassociatedwithlessadherence,ing to treatment. Smartphone apps forSource: Primary Progressive Multiple Sclerosis: What You eitherduetoforgettingtotakethemimprovingMSmedicationadherenceNeed to Know, jointly published by MSAA and NMSor dosing fatigue. In general, VA hashave also had some limited success.found self-injected medications to haveWhat medications a patient is prescribedneurologyatGeorgeWashington the poorest adherencea finding mir- at the start can also have a big impact onUniversityandtheUniversityof roredoutsideVA,aswell.Injectionwhether they take them regularly. Maryland School of Medicine, pointed anxiety, researchers have found, can beInitialselectionofthemedicationout that people are living longer across a very strong, specific barrier to patientsthatbestfitseachindividualsgoalsthe board, adding, You can see that in taking a medication. At the start of theandtheunderstandingoftheirsidethe mortality data; the average age of study, most patients, 95.27%, were oneffects is essential, explained officialsthe MS population has gone up.aninjectable,disease-modifyingther- from the VA MS Centers of Excellence.Askedwhy,herespondedthatthe apy, but by the end of the study the per- Ongoingcommunicationabouttheimprovement in mortality rates can be centageoninjectableDMTsdroppedfrequency of missed doses, encourage- attributed some to new medicines, but to 81.11%, with an increasing numberment,andreassessmentoflong-termwere also treating infection better and using or transitioning to oral medica- goals and benefits is also critical. increasing mobility.tions, the researchers noted. Stickingtotreatmentregimenscan1Gromisch ES, Turner AP, Leipertz SL, have an effect on now long MS patientsBeauvais J, Haselkorn JK. Risk Factors for i mprovinga dherence survive. In a previous interview withSuboptimal Medication Adherence in Persons VA has engaged in several studies exam- U.S.Medicine,MitchellWallin,MD,With Multiple Sclerosis: Development of an ining ways to improve MS medicationMPH,directoroftheMSCenterofElectronic Health Record-Based Explanatory Model for Disease-Modifying Therapy Use. adherence. In a small trial conducted byExcellence-East, based in Washington,Arch Phys Med Rehabil. 2020;101(5):807-814. VAsMSCentersofExcellence,briefDC,andassociateprofessorofdoi:10.1016/j.apmr.2019.11.005242020 COMPENDIUM OF FEDERAL MEDICINE'