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Finkener S, Achtnichts L, Cervenakova M, Nedeltchev K, Findling O. Oral disease modifying therapies - A game changer for treatment decision in untreated patients with RRMS and CIS? - A swiss single center cross-sectional study. Mult Scler Relat Disord 2022; 68:104396. [PMID: 36544325 DOI: 10.1016/j.msard.2022.104396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/19/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Several disease-modifying therapies (DMTs) show efficacy in relapsing-remitting multiple sclerosis (RRMS) and clinically isolated syndrome (CIS). However, there is still a relevant proportion of patients who remain untreated. We provide real-world data on untreated and treated patients and we report whether and how the introduction of oral DMTs changed the treatment decision. Furthermore, we discuss possible reasons for not receiving DMTs. METHODS We conducted a retrospective cross-sectional study and analysed demographic and clinical data of patients with RRMS and CIS at our MS center. Comparison was made between untreated and treated patients in 2010 (before the introduction of oral DMTs) and in 2014 (after the introduction of oral DMTs). Furthermore, we analysed reasons for the decision against DMTs in patients who never received DMTs and patients who discontinued DMTs. RESULTS We analysed datasets of 344 MS patients in 2010 and 253 in 2014. There were more untreated patients in CIS than in RRMS. In RRMS, the proportion of untreated patients decreased significantly between 2010 and 2014 from 23.6% to 11.1%, while the use of oral medications increased significantly from <1% to more than 50% in 2014. In CIS, there was no significant change in untreated patients between 2010 and 2014 (61.1% in 2010 to 52.6% in 2014). Untreated patients with RRMS were significantly older and had lower ARR than treated patients. Patients who never received DMT had lower EDSS compared to patients that had been treated before. The main reasons for the decision against DMT were "belief in a benign course" and "fear of adverse effects". Treatment discontinuation was caused mainly by the adverse effects. DISCUSSION In our data a relevant proportion of patients with RRMS and CIS did not receive any DMT. We hypothesize that in patients with RRMS the introduction of oral DMTs translated to a higher rate of treatment, whereas in CIS there no change was observed. This could be due to limited therapeutic options in CIS. There is more information needed regarding the treatment recommendation for older patients and patients with mild course of the disease.
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Affiliation(s)
| | - Lutz Achtnichts
- Department of Neurology, Aarau Cantonal Hospital, Aarau, Switzerland
| | | | - Krassen Nedeltchev
- Department of Neurology, Aarau Cantonal Hospital, Aarau, Switzerland; University of Bern, Bern, Switzerland
| | - Oliver Findling
- Department of Neurology, Aarau Cantonal Hospital, Aarau, Switzerland; MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel(RC2NB),Head, Spine and Neuromedicine, Clinical Research and Biomedicine and Biomedical Engineering, University Hospital and University of Basel, Basel, Switzerland
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Oliver S, Douglas J, Winkler D, Pearce C, Minter E, Jarman HK, Topping M. The healthcare needs and general practice utilization of people with acquired neurological disability and complex needs: A scoping review. Health Expect 2022; 25:2726-2745. [PMID: 36322481 PMCID: PMC9700155 DOI: 10.1111/hex.13640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/13/2022] [Accepted: 10/16/2022] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND For people with acquired neurological disabilities and complex needs, general practitioners (GPs) play an important role in health management and early intervention for the prevention of comorbidities and health complications. People with disability are a vulnerable group who need and have the right to, quality general practice services. It is therefore important to understand the health needs and service use of this group. The aim of this review was to identify the healthcare needs and general practice utilization of people with acquired neurological disabilities and complex needs. METHODS A scoping review methodological framework was utilized. Six databases (MEDLINE, PsycInfo, CINAHL, Scopus, Embase and the Cochrane Library) were searched. Articles were included if they reported on general practice service utilization of people with acquired neurological disabilities and complex needs aged between 18 and 65. Articles were required to be peer-reviewed, written in English and published between 2010 and 2021. RESULTS Thirty-one articles were included in the review. Studies originated from Canada (9), the United States (8), Australia (4), Switzerland (4), the United Kingdom (2), England (1), Norway (1), France (1) and Denmark (1). For many people, GPs were the main healthcare provider. People with disability consult multiple healthcare providers and navigate complex healthcare systems. Commonly presented healthcare needs were bladder, bowel and skin problems, pain and chronic pain, medication needs and mental health concerns. CONCLUSIONS People with acquired neurological disabilities and complex needs were vulnerable to receiving suboptimal healthcare. The literature highlighted issues regarding the accessibility of services, the fragmentation of health services and inadequate preventative care. GPs were challenged to offer adequate disability-related expertise and to meet the mental health needs of people with disability within time constraints. PATIENT AND PUBLIC INVOLVEMENT This manuscript was prepared in collaboration with a GP, who is one of the authors. A person with lived experience of acquired neurological disability was engaged to check the alignment of the findings with their personal experience and provide feedback.
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Affiliation(s)
- Stacey Oliver
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Jacinta Douglas
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Dianne Winkler
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | | | - Ella‐Rose Minter
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Hannah K. Jarman
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
| | - Megan Topping
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
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Veillard D, Le Page E, Epstein J, Wiertlewski S, Gallien P, Hamonic S, Debouverie M, Edan G. Evaluation of the quality of the care pathway for patients with multiple sclerosis in France: Results of an original study of a cohort of 700 patients. Rev Neurol (Paris) 2021; 178:580-590. [PMID: 34893353 DOI: 10.1016/j.neurol.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Evaluating the quality of the care pathway for patients with chronic diseases, such as multiple sclerosis (MS), is an important issue. Process indicators are a recognized method for evaluating professional practices. However, these tools have been little developed in the field of MS, and few data are available. The aim of this study was to describe, retrospectively, with validated indicators, the quality of the care pathway in a population-based cohort of 700 patients with the first manifestations of the disease occurring between January 1, 2000 and December 31, 2001 and during the first 10 years of disease. METHOD This assessment was based on 48 indicators specific to MS. The information required for the calculation of each indicator was collected from the source files of the 700 patients of the cohort. RESULTS Data for the 10 years of follow-up were collected for 80% of the patients. In total, 36 indicators were calculated. These results reveal that there is room for improvement, particularly in terms of the initial assessment, access to ophthalmological evaluation, employment, obtaining an evaluation of the need for rehabilitation and access to such care. CONCLUSION The results of this survey provide access to unprecedented new data in France, that professionals and patients can appropriate to improve the targeting of actions, to improve the quality of care further for patients with MS in France. We propose to continue this process by submitting, for discussion, a targeted list of updated indicators relating to changes in guidelines, and in issues concerning the quality of patient management.
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Affiliation(s)
- D Veillard
- Service d'épidémiologie et de santé publique, CHU, 35000 Rennes, France; Équipe d'accueil 3279, centre d'études et de recherche sur les services de santé, Aix-Marseille Université, 13000 Marseille, France.
| | - E Le Page
- Inserm, service de neurologie, Clinical Neuroscience Center CIC-P 1414, CHU, 35000 Rennes, France.
| | - J Epstein
- Service d'épidémiologie, clinique du centre hospitalier universitaire and Clinical Investigation Center CIC 1433, 54000 Nancy, France.
| | - S Wiertlewski
- Clinique neurologique, CHU de Nantes, 44000 Nantes, France.
| | - P Gallien
- Pôle de médecine physique et de rehabilitation Saint-Hélier, 35000 Rennes, France.
| | - S Hamonic
- Service d'épidémiologie et de santé publique, CHU, 35000 Rennes, France.
| | - M Debouverie
- Équipe d'accueil 4360 adaptation, mesure et évaluation en santé, approches interdisciplinaires, service de neurologie, université de Lorraine, CHU de Nancy, 54000 Nancy, France.
| | - G Edan
- Inserm, Clinical Neuroscience Centre, CIC-P 1414, Université de Rennes 1, 35000 Rennes, France.
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Pétrin J, McColl MA, Donnelly C, French S, Finlayson M. Prioritizing the healthcare access concerns of Canadians with MS. Mult Scler J Exp Transl Clin 2021; 7:20552173211029672. [PMID: 34290879 PMCID: PMC8276490 DOI: 10.1177/20552173211029672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Canadians with MS are high users of healthcare services, yet they report multiple unmet needs, high disease burden, and low satisfaction with care. Engaging patients in healthcare planning can lead to improvements in access and care. There is currently limited evidence that has harnessed the perspectives of Canadians with MS. Objective To identify and prioritize the healthcare access concerns of Canadians with MS. Methods A cross-sectional online survey informed by the Concerns Report Methodology was used to address the objective. Participants were recruited through multiple methods. Descriptive statistics were used to identify the main barriers to healthcare providers, and concerns report methods were used to calculate needs indexes to prioritize concerns of participants. Results 324 Canadians with MS participated in the study between November 18, 2019 and March 27, 2020. The most pressing healthcare access concerns of Canadians with MS were related to availability of healthcare providers with MS knowledge and affordability of services that aim to improve wellness. Conclusion These findings provide healthcare planners with prioritized access concerns of Canadians with MS, which can be used to guide strategic planning to improve the quality of life of these individuals.
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Affiliation(s)
- Julie Pétrin
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Simon French
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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The Effect of Depression on Health-Related Quality of Life Is Mediated by Fatigue in Persons with Multiple Sclerosis. Brain Sci 2021; 11:brainsci11060751. [PMID: 34198920 PMCID: PMC8227168 DOI: 10.3390/brainsci11060751] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022] Open
Abstract
The interrelations between fatigue, depression and health-related quality of life (HRQoL) in persons with multiple sclerosis (PwMS) are complex, and the directionality of the effects is unclear. To address this gap, the current study used a longitudinal design to assess direct and indirect effects of fatigue and depression on HRQoL in a one-year follow-up survey. A sample of 210 PwMS from the nationwide Swiss MS Registry was used. HRQoL was assessed using the European Quality of Life 5-Dimension 5-Level questionnaire. Path analysis on HRQoL, with fatigue and depression as predictors, was applied. Fatigue was measured by the Modified Fatigue Impact Scale (MFIS), including physical, cognitive and psychosocial subscales, and non-somatic depressive symptomatology was examined with the Beck Depression Inventory-Fast Screen (BDI-FS). Fatigue acted as a fully mediating variable (B = -0.718, SE = 0.253) between non-somatic depressive symptomatology and HRQoL. This indirect effect became apparent in the physical (B = -0.624, SE = 0.250), psychosocial (B = -0.538, SE = 0.256) and cognitive subscales (B = -0.485, SE = 0.192) of fatigue. In contrast, non-somatic depressive symptomatology did not act as a mediator. Our findings provide novel and clinically relevant longitudinal evidence showing that the debilitating effect of non-somatic aspects of depression on HRQoL was fully mediated and therefore explainable via fatigue.
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Roux J, Kingwell E, Zhu F, Tremlett H, Leray E. Care consumption of people with multiple sclerosis: A multichannel sequence analysis in a population-based setting in British Columbia, Canada. Mult Scler 2021; 28:309-322. [PMID: 34048293 DOI: 10.1177/13524585211016726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Persons with multiple sclerosis (PwMS) typically require complex multidisciplinary care, which is rarely formally assessed. OBJECTIVES We applied multichannel sequence analysis (MCSA) to identify care consumption patterns by PwMS in British Columbia, Canada. METHODS We created two cohorts, comprising incident and prevalent MS cases, using linked clinical and administrative data. We applied MCSA to quantify and compare the care pathways of PwMS, based on all-cause hospitalizations and physician visits (divided into five specialities). Care consumption clusters were characterized using demographic and clinical features. RESULTS From 1048 incident and 3180 prevalent PwMS, the MCSA identified 12 and 6 distinct care consumption clusters over a median follow-up of 9.6 and 13.0 years, respectively. Large disparities between clusters were observed; the median number of annual consultations ranged from 5.6 to 21.3 for general practitioners, 1.2 to 4.6 for neurologists and 0 to 5.3 for psychiatrists in the incident cohort. Characteristics at MS symptom onset associated with the highest care consumption included high comorbidity burden and older age. There were similar disparities and associations for prevalent PwMS. CONCLUSION The distinct patterns of care consumption, which were reminiscent of the heterogeneity of MS itself, may facilitate health service planning and evaluation, and provide a novel outcome measure in health research.
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Affiliation(s)
- Jonathan Roux
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and Health Services Research), Rennes, France/Inserm CIC-P 1414, CHU of Rennes, Rennes, France
| | - Elaine Kingwell
- Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada/Research Department of Primary Care & Population Health, University College London, London, UK
| | - Feng Zhu
- Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Helen Tremlett
- Faculty of Medicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Emmanuelle Leray
- Univ Rennes, EHESP, REPERES (Pharmacoepidemiology and Health Services Research), Rennes, France/Inserm CIC-P 1414, CHU of Rennes, Rennes, France
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Multiple Sclerosis Clinic Utilization is Associated with Fewer Emergency Department Visits. Can J Neurol Sci 2021; 49:393-397. [PMID: 34027837 DOI: 10.1017/cjn.2021.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Alberta is a Canadian province with a high prevalence of multiple sclerosis (MS). In this ecological study, we examined group differences in health care utilization among persons with MS (pwMS) living within different regions of the province. METHODS pwMS were identified from provincial administrative databases spanning 2002-2011. Utilization of health care services was determined for a 2-year period (April 2010-March 2012). Residential postal codes placed patients into their provincial health care zones. As data were provided to the investigators in an aggregated form, tests of statistical significance and confounding were not performed. RESULTS In total, 11,721 pwMS were identified. During the 2-year observation period, 96.2% of pwMS accessed a family physician and 57.1% accessed a neurologist. Nearly all (99.0%) pwMS who received neurologist care in Calgary visited an MS clinic, in contrast to Edmonton where a larger proportion (34.8%) received solely community neurologist care. More pwMS living in Edmonton accessed the ED (41.1%) compared to Calgary (35.7%), and the rate of visits per pwMS was higher in Edmonton (1.07/pwMS) than in Calgary (0.81/pwMS). The frequency of inpatient admissions was similar. CONCLUSIONS Over 2 years, most pwMS accessed primary care and over half saw a neurologist. Despite a similar frequency of inpatient admissions, the frequency of ED visits by pwMS was higher in Edmonton compared to Calgary, where more patients received MS clinic care. Although this exploratory study is subject to several limitations, our findings suggest that specialized MS clinics may reduce costly ED visits.
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Demir S, Tutuncu M, Uzunkopru C, Gumus H, Sen S, Gunduz T, Dogan IG, Cinar BP, Incirli SU, Tutuncu M, Mavi K, Yuksel S, Togrol RE, Kocaman AS, Siva A. A comprehensive assessment of patient experience and disease-related awareness in multiple sclerosis: A questionnaire-based nation-wide survey in Turkey. Mult Scler Relat Disord 2021; 52:103005. [PMID: 34000682 DOI: 10.1016/j.msard.2021.103005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/22/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Comprehensive assessment of multiple sclerosis (MS) patients in terms of patient profile, clinical and disease-related factors has great epidemiological value. This study aimed to evaluate patient experience and disease-related awareness in MS patients through a nation-wide survey in Turkey Methods: A total of 1379 MS patients participated in this cross-sectional questionnaire survey conducted between November 2018 and December 2018. The online questionnaire form included items on sociodemographic, disease-related, first-admission, treatment and follow up characteristics as well as the disability status. RESULTS Patients were diagnosed at median 28.0 years of age, while the average time from admission to diagnosis and time from diagnosis to treatment were 1.2 years and 2.5 months, respectively. Neurology (45.4%) and ophthalmology (23.3%) were the most common clinics for the first admission, while numbness-weakness in lower and upper extremities (37.6%) and double vision-visual problems (30.6%) were the most common symptoms on initial admission. Treatment was initiated after the diagnosis in 1213(88.0%) patients, while 166 (12.0%) patients were treatment-naïve. Treatment discontinuation, treatment switch and use of alternative treatment methods were reported by 31.3%, 49.3% and 22.8% of patients, respectively. The ophthalmology admissions (with double vision or visual problems) were associated with the shortest time from presentation to diagnosis as compared with neurosurgery and internal medicine admissions (median 1.0 vs. 3.0 and 4.0 months, p<0.001). The neurology admissions (with numbness-weakness in extremities) were associated with more prompt (median 0.3 vs. 0.5 months, p=0.032) and more frequent onset of treatment after diagnosis (64.5% vs. 2.2% to 15.2%, p<0.001). Time from presentation to diagnosis was longer in patients aged >50 years (median 6.0 months vs. 2.0 months, p<0.001), in patients using alternative medicine (median 3.0 months vs. 1 month, p=0.001) and in patients admitted to a non-MS-center (median 3.0 months vs. 2.0 months, p=0.002). Median (min-max) age at diagnosis was significantly lower in patients with vs. without treatment discontinuation for any reason (26.0(10-56) vs. 29.0(3-60) years, p<0.001) and treatment switching (27.0(5-93) vs. 30.0(3-60) years, p<0.001). CONCLUSIONS In conclusion, our findings revealed higher likelihood of earlier diagnosis and earlier treatment in patients admitted to an MS-center and in those presenting with ocular problems and sensory-motor deficits, respectively. Our findings also emphasize the association of older patient age with higher likelihood of diagnostic delay, and increased likelihood of treatment discontinuation for any reason and/or treatment switching in case of older patient age, younger age at diagnosis and diagnostic delay. In this regard, our findings highlight the need for improved awareness among patients as well as clinicians on initial manifestations of MS to enable admission or referral to an MS-center and to prevent delay in diagnosis, particularly for onset symptoms other than ocular or sensory-motor characteristics.
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Affiliation(s)
- Serkan Demir
- Department of Neurology, University of Health Sciences Sehit Prof. Dr. Ilhan Varank Sancaktepe Research and Training Hospital, Istanbul, Turkey.
| | - Melih Tutuncu
- Department of Neurology, Istanbul University Cerrahpasa University Faculty of Medicine, Istanbul, Turkey.
| | - Cihat Uzunkopru
- Department of Neurology, Katip Celebi University Faculty of Medicine, Izmir, Turkey.
| | - Haluk Gumus
- Department of Neurology, Selcuk University Faculty of Medicine, Konya, Turkey.
| | - Sedat Sen
- Department of Neurology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
| | - Tuncay Gunduz
- Department of Neurology Istanbul, University Istanbul Faculty of Medicine, Istanbul, Turkey.
| | - Ipek Gungor Dogan
- Department of Neurology, University of Health Sciences Sehit Prof. Dr. Ilhan Varank Sancaktepe Research and Training Hospital, Istanbul, Turkey.
| | - Bilge Piri Cinar
- Department of Neurology, Zonguldak Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey.
| | - Sila Usar Incirli
- Department of Neurology, Burhan Nalbantoglu State Hospital, Lefkosia, Northern Cyprus.
| | - Mesude Tutuncu
- Department of Neurology, University of Health Sciences Bakirkoy Mental Health and Neurology Training and Research Hospital, Istanbul, Turkey.
| | - Kamil Mavi
- Novartis Pharmaceuticals, Istanbul, Turkey.
| | | | - Rifat Erdem Togrol
- Department of Neurology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey.
| | - Ayse Sagduyu Kocaman
- Department of Neurology, Acibadem University Faculty of Medicine, Istanbul, Turkey.
| | - Aksel Siva
- Department of Neurology, Istanbul University Cerrahpasa University Faculty of Medicine, Istanbul, Turkey.
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Pétrin J, Finlayson M, Donnelly C, McColl MA. Healthcare access experiences of persons with MS explored through the Candidacy Framework. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:789-799. [PMID: 33606904 DOI: 10.1111/hsc.13320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/14/2020] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
Canada has one of the highest rates of multiple sclerosis (MS) in the world, affecting 1 in every 385 individuals. This neurodegenerative condition is unpredictable and variable in symptom profile and disease course making it difficult to manage. Canadians with MS are high users of healthcare services; however, they report multiple unmet needs, high disease burden, and low satisfaction with healthcare. Access to healthcare is vital to health maintenance and may explain these poor experiences. Access is often measured using utilisation as a proxy, which may fail to capture the complexities of access experiences that this population faces. The Candidacy Framework offers an alternative to utilisation measures, by examining the process of accessing care, while considering the impact of social patterning and health system environments on this process. The aim of the current study is to align the experiences of persons with MS in accessing healthcare services with the stages of the Candidacy Framework. Forty-eight individuals with MS living across Ontario were recruited to participate in one of five focus groups or ten individual interviews. Analysis included a first inductive phase, using constant comparative methods, followed by a deductive phase, using content analysis. The Candidacy Framework was not able to capture all experiences shared by persons with MS, including patient-centred care, past experiences and outcome expectation, and care outcomes. We propose these concepts be included as refinements to the current Framework, providing a more thorough explanation of the experiences of persons with MS in accessing care to manage their condition.
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Affiliation(s)
- Julie Pétrin
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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10
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Fortunato R, van der Maas NA, Biland-Thommen U, Kaufmann M, Sieber C, Kamm CP, Zecca C, Gobbi C, Chan A, Calabrese P, Kesselring J, von Wyl V. Physiotherapy use and access-barriers in persons with multiple sclerosis: A cross-sectional analysis. Mult Scler Relat Disord 2020; 48:102710. [PMID: 33370648 DOI: 10.1016/j.msard.2020.102710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/08/2020] [Accepted: 12/20/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Physiotherapy may alleviate many multiple sclerosis (MS) symptoms, yet very little is known about physiotherapy accessibility and possible barriers in persons with MS (pwMS). We therefore aimed to elucidate physiotherapy use and possible access-barriers using data from 1493 pwMS from the Swiss Multiple Sclerosis Registry (SMSR), a patient-centered, longitudinal, observational MS study. METHODS We used data of the SMSR to investigate the question at hand in a multivariable logistic regression model with regularly receiving physiotherapy (yes/no) as the outcome. Potential explanatory variables were investigated following an AIC-driven model selection approach and consisted of a priori specified socio-demographic variables, health status, and personal or social mobility variables. As a last step, the impact of physiotherapist supply on regular use was assessed in the final model. Missing data were handled by multiple imputation (main analysis), and complete case sensitivity analyses were performed. RESULTS The main analysis included 1493 participants. In the multivariable logistic regression, positive associations were found between the use of physiotherapy and the following variables: having a primary-progressive MS (Odds Ratio (OR) [95% Confidence Intervals] 1.97 [1.18; 3.29]), being more severely impaired (EDSS 4-6.5 OR 1.84 [1.16; 2.91]), higher number of current symptoms (1 OR 3.31 [1.63; 6.74], 2-3 OR 3.43 [1.8; 6.53], 4-5 OR 4.44 [2.28; 8.66], 6-7 OR 4.06 [1.90; 8.70], 8-9 OR 3.87 [1.71; 8.75], being on disability pension (OR 1.75 [1.24; 2.46], or having applied for it OR 2.25 [1.31; 3.85]), having gait problems (OR 1.58 [1.11; 2.23]), having been in a rehabilitation clinic in the past 12 months (OR 4.43 [2.17; 9.03]), and currently being on disease-modifying treatment (OR 1.61 [1.12; 2.31]). Negative associations were found for a higher quality of life (OR 0.92 [0.85; 0.98]), working more than 80% (OR 0.47 [0.30; 0.75]) and being from the French language region (OR 0.66 [0.47; 0.94]). No association between physiotherapist supply and regular physiotherapy use was detected. DISCUSSION In a large, Swiss-based MS population, little evidence for socio-demographic barriers to physical therapy was found. Physiotherapy uptake was higher among pwMS with more impairments, lower health-related quality of life, or who have been discharged recently from inpatient rehabilitation. The uptake differences by language region warrant further investigations.
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Affiliation(s)
- Remo Fortunato
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | | | | | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Chloé Sieber
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Christian P Kamm
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland; Neurocentre, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Chiara Zecca
- Faculty of biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland; Department of Neurology, Multiple Sclerosis Center (MSC), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Claudio Gobbi
- Faculty of biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland; Department of Neurology, Multiple Sclerosis Center (MSC), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Andrew Chan
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Jürg Kesselring
- Department of Neurology and Neurorehabilitation, Rehabilitation Center, Valens, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland.
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Factors associated with employment and expected work retention among persons with multiple sclerosis: findings of a cross-sectional citizen science study. J Neurol 2020; 267:3069-3082. [PMID: 32529580 PMCID: PMC7501110 DOI: 10.1007/s00415-020-09973-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 11/29/2022]
Abstract
Background Multiple sclerosis (MS) notably affects adults of working age. For persons with MS (PwMS), being employed enhances their quality of life and it may be regarded as an indicator of overall functioning. Thus, ensuring work participation in PwMS is of general public health interest. Objective To examine relevant socio-demographic, MS-, health- and work-related factors, including psychosocial working conditions, associated with currently working PwMS in Switzerland and their expected work retention. Methods Using cross-sectional data of PwMS in the Swiss MS Registry (n = 541, median age = 48 [IQR 40;55]), multivariable logistic regression models were computed. First, currently working PwMS were characterised in comparison with those not currently working. Second, expected work retention, operationalized as subjective judgement “likely to work in the same job in 2 years”, was examined within the group of currently working PwMS. Results The factors age (OR 0.96, 95% CI 0.92–0.99), sex (OR 0.28, 95% CI 0.13–0.60), highest achieved job position (OR 1.21, 95% CI 1.01–1.46), health-related quality of life (HRQoL) (OR 1.02, 95% CI 1.01–1.04) and the number of MS symptoms (OR 0.90, 95% CI 0.82–0.98) were associated with currently working PwMS. Moreover, HRQoL (OR 1.07, 95% CI 1.04–1.10) and psychosocial working conditions, such as job resources (e.g. autonomy, control or social support) (OR 2.83, 95% CI 1.50–5.33) and job demands (e.g. workload, time pressure) (OR 0.41, 95% CI 0.18–0.90) were important factors for expected work retention among this group. Conclusions Resourceful psychosocial working conditions are crucial for PwMS to maintain employment. Employers could contribute to work retention among PwMS by creating a work environment with resourceful psychosocial working conditions and providing, for instance, social support. Electronic supplementary material The online version of this article (10.1007/s00415-020-09973-3) contains supplementary material, which is available to authorized users.
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Kaufmann M, Puhan MA, Kuhle J, Yaldizli Ö, Magnusson T, Kamm CP, Calabrese P, von Wyl V. A Framework for Estimating the Burden of Chronic Diseases: Design and Application in the Context of Multiple Sclerosis. Front Neurol 2019; 10:953. [PMID: 31555205 PMCID: PMC6742909 DOI: 10.3389/fneur.2019.00953] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/20/2019] [Indexed: 12/27/2022] Open
Abstract
Background: When population-based databases are unavailable, nationwide assessments of the disease burden of multiple sclerosis (MS) resort to clinical, administrative or convenience-sampled data sources, which may produce results of limited external validity. Our aim was to develop a framework for estimating measures of occurrence of chronic diseases, and more broadly disease burden, that mitigate these limitations and to apply this framework to estimate the prevalence of multiple sclerosis (MS) in Switzerland. Methods: We developed a 7-step framework which implements the combination of several data sources together with a resampling and critical appraisal approach. The framework was applied to estimate the MS prevalence for 2016 in Switzerland, for which four distinct data sources (Swiss MS registry, Swiss national MS treatment registry, MediService database, and Swiss MS cohort study) were combined. Results were reviewed by disease experts and compared to earlier Swiss estimates and current prevalence estimates from other countries. Results: We estimate that in the year 2016 between 14,650 and 15,700 persons with MS have been living in Switzerland, yielding a period prevalence of 174–187/100,000 inhabitants. Compared to the last estimate in 1986, we detected a substantial increase of MS diagnoses which coincides with a higher number of diagnoses in women below the age of 65. Conclusions: Internationally, Switzerland is a high-prevalence country for MS, although estimates were somewhat lower than recent evaluations of Northern European countries. In addition, we corroborate previous reports that the prevalence increase coincides with a higher number of MS diagnoses among women. The proposed framework has wide applicability and the potential to place estimates of disease occurrence and burden with imperfect data availability on more solid grounds.
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Affiliation(s)
- Marco Kaufmann
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo Alan Puhan
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jens Kuhle
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Özgür Yaldizli
- Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | | | - Christian P Kamm
- Neurology and Neurorehabilitation Centre, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, University of Basel, Basel, Switzerland
| | - Viktor von Wyl
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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13
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Barin L, Kamm CP, Salmen A, Dressel H, Calabrese P, Pot C, Schippling S, Gobbi C, Müller S, Chan A, Rodgers S, Kaufmann M, Ajdacic-Gross V, Steinemann N, Kesselring J, Puhan MA, von Wyl V. How do patients enter the healthcare system after the first onset of multiple sclerosis symptoms? The influence of setting and physician specialty on speed of diagnosis. Mult Scler 2019; 26:489-500. [PMID: 31456464 PMCID: PMC7140343 DOI: 10.1177/1352458518823955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Diagnosing multiple sclerosis (MS) early is crucial to avoid future
disability. However, potentially preventable delays in the diagnostic
cascade from contact with a physician to definite diagnosis still occur and
their causes are still unclear. Objective: To identify the possible causes of delays in the diagnostic process. Methods: We analyzed the data of the Swiss MS Registry. With logistic regression, we
modeled the time from the first contact to the first consultation
(contact-to-evaluation time, ⩽1 month/>1 month) and the
evaluation-to-diagnosis time (⩽6 months/>6 months). Potential factors
were health system characteristics, sociodemographic variables, first
symptoms, and MS type. Results: We included 522 participants. Mostly, general practitioners (67%) were
contacted first, without delaying the diagnosis. In contrast, first symptoms
and MS type were the major contributors to delays: gait problems were
associated with longer contact-to-evaluation times, depression as a
concomitant symptom with longer evaluation-to-diagnosis times, and having
primary progressive MS prolonged both phases. In addition, living in
mountainous areas was associated with longer contact-to-evaluation times,
whereas diagnosis after 2000 was associated with faster diagnoses. Conclusion: For a quicker diagnosis, awareness of MS as a differential diagnosis of gait
disorders and the co-occurrence of depression at onset should be raised, and
these symptoms should be attentively followed.
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Affiliation(s)
- Laura Barin
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Christian P Kamm
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland/Neurology and Neurorehabilitation Centre, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Anke Salmen
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Holger Dressel
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland/Division of Occupational and Environmental Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Pasquale Calabrese
- Neuropsychology and Behavioral Neurology Unit, Division of Molecular and Cognitive Neuroscience, Department of Psychology, University of Basel, Basel, Switzerland
| | - Caroline Pot
- Laboratories of Neuroimmunology, Division of Neurology and Neuroscience Research Center, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Sven Schippling
- Neuroimmunology and Multiple Sclerosis Research, Department of Neurology, University Hospital Zurich, Zurich, Switzerland/Center for Neuroscience Zurich, Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Claudio Gobbi
- Neurocenter of Southern Switzerland, Ospedale regionale di Lugano, Lugano, Switzerland
| | - Stefanie Müller
- Department of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Andrew Chan
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Stephanie Rodgers
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Kaufmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Vladeta Ajdacic-Gross
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland/Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Nina Steinemann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jürg Kesselring
- Department of Neurology and Neurorehabilitation, Rehabilitation Centre Kliniken Valens, Valens, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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