1 Study Details

1.1 Background

Patient reported outcomes (PROs), defined as a measurement of any aspect of a patient’s health status that comes directly from the patient, are an effective took for understanding patient insights into their disease management, quality of life and functioning and can help inform clinical decision making and improve quality of care. VSP’s current workflow captures specific PROs during monthly refill assessments and alerts the pharmacist of any negative findings. An integrated clinic pharmacist then performs a variety of interventions to facilitate medication adherence and identify medication safety or effectiveness or further coordination of care.

1.2 Objectives

  • Quantify patient-reported response to therapy

  • Quantify number and type of pharmacist interventions performed during monthly refill assessments.

1.3 Inclusion Criteria

  • Patients must have at least 2 medications fills through VSP

  • Patients must have at least 2 MRQ responses

  • Medication fills must have occurred between January and March 2020 `

  • Medication must be prescribed by a VUMC multiple sclerosis clinic provider

2 Descriptive statistics

2.1 Demographics and patient characteristics

There are 335 unique patients that completed 1017 MRQs.

Baseline Descriptive Statistics, Diagnosis, and Medication.

N=335
Age 45.0 52.3 59.9
Gender
    Female 0.76 (256)
    Male 0.24 ( 79)
Race
    White 0.82 (274)
    Black or African American 0.15 ( 50)
    American Indian or Alaska Native 0.00 ( 1)
    Other Asian 0.00 ( 1)
    Unknown 0.03 ( 9)
Ethnicity
    Not Hispanic, Latino/a, or Spanish origin 0.95 (319)
    Unknown 0.04 ( 12)
    Other Hispanic, Latino/a, or Spanish origin 0.01 ( 4)
Insurance Type
    Commercial 0.59 (196)
    Medicare 0.38 (127)
    Medicaid 0.04 ( 12)
Speciality Med
    Ampyra/XR (dalfampridine) 0.10 (33)
    Aubagio (teriflunomide) 0.10 (32)
    Gilenya (fingolimod) 0.22 (74)
    glatiramer acetate 0.17 (56)
    interferon beta-1a 0.17 (56)
    interferon beta-1b 0.04 (13)
    Mayzent (siponimod) 0.00 ( 1)
    Plegridy (peginterferon beta-1a) 0.02 ( 7)
    Tecfidera (dimethyl fumarate) 0.19 (63)
MS Indication
    Relapsing-remitting 0.88 (295)
    Primary progressive 0.03 ( 11)
    Secondary progressive 0.08 ( 27)
    Tumefactive 0.00 ( 1)
    Clinically isolated syndrome 0.00 ( 1)
a b c represent the lower quartile a, the median b, and the upper quartile c for continuous variables. Numbers after proportions are frequencies.

2.1.1 Specialty medication by Indication

Medication by Indication
Relapsing-remitting Primary progressive Secondary progressive Tumefactive Clinically isolated syndrome
Ampyra/XR (dalfampridine) 13 8 12 0 0
Aubagio (teriflunomide) 27 0 4 1 0
Gilenya (fingolimod) 71 1 2 0 0
glatiramer acetate 53 0 3 0 0
interferon beta-1a 54 0 1 0 1
interferon beta-1b 12 0 1 0 0
Mayzent (siponimod) 0 1 0 0 0
Plegridy (peginterferon beta-1a) 7 0 0 0 0
Tecfidera (dimethyl fumarate) 58 1 4 0 0

3 MRQ

3.1 Count of MRQs per patient

3.2 Missed doses

3.2.1 Missed Doses Per Patient

Descriptive Statistics (N=335).

N=335
Number of Missed Doses
    0 0.90 (301)
    1 0.09 ( 31)
    2 0.01 ( 3)
Numbers after proportions are frequencies.

3.2.2 Missed Doses in the last month per MRQ

Missed doses in the last month per MRQ.

N=1017
num_missed_doses
    1-2 doses 0.02 ( 25)
    3-4 doses 0.01 ( 7)
    5 or more doses 0.00 ( 5)
    NA 0.96 (980)
Numbers after proportions are frequencies.

3.2.3 Reasons for missed doses

The checkbox variables were combined into one in the box data.

Reasons for Missed Doses by MRQ
Reasons Frequency
Forgetfulness 22
Ran Out of Medication 6
Other 3
Intolerance / Side Effects 2
Purposefully Held Due to Illness or Procedure 2
Financial Barrier 1
Medication Remaining, but Unavailable (i.e. left at home when traveling) 1
Patient was in Hospital 1
Pending Labwork 1

3.3 Patient perceived efficacy

3.3.1 Table

Patient reported medication effictiveness.

N=1017
Effectiveness
    Poor 0.00 ( 1)
    Fair 0.02 ( 17)
    Good 0.66 (668)
    Excellent 0.33 (331)
Numbers after proportions are frequencies.

3.3.2 Visualization

3.4 Adverse effects

3.4.1 Count of adverse effects

Adverse effects by MRQ.

N=1017
adverse_effects
    No 0.99 (1011)
    Yes 0.01 ( 6)
Numbers after proportions are frequencies.

3.4.2 Side effect details

Side Effect Details
flu-like symptoms - mild/moderate
Patient stated when taking the medication it feels like her face has a burning sensation
Hair loss. Provider aware. Patient will continue to take medication. No follow up needed.
flushing
patient has had a headache for approx. 1 week, she stated that she was going to reach out to her doctor and discuss
Dermatitis- she will be going to the doctor about the condition next week

4 Pharmacist Interventions

4.1 Number of Interventions per Patient

4.2 Types of Interventions

Total count of types of pharmacist interventions by intervention
Interventions Frequency
Adherence/Missed Dose 39
Therapeutic Monitoring - Safety 36
Common Side Effect/Toxicity 20
Other 15
Condition-Related Concern or Exacerbation 13
Coordination of Care 11
Financial/Insurance Issue 9
Medication List Change 8
ED/Hospitalization/Urgent Care Visit 6
New Condition or Diagnosis Identified 6
Medication Interaction 5
Adverse Event 2
Drug Administration Question 2
Drug Stability and Storage Question 2
Drug Dosing Question 1

4.3 Outcomes of Interventions

Total count of outcomes of pharmacist interventions by intervention
Interventions Frequency
Identified Issue Resolved 127
Identified Issue Unresolved 4
Recommendation to Provider Accepted 3
Dosage Adjustment Made 2
Follow-Up Care Scheduled (Lab/Appointment) 2
Alternative Therapy Started 1