Elizabeth S. Gromisch , Aaron P. Turner , Steven L. Leipertz , John Beauvais , Jodie K. Haselkorn
{"title":"不参加预约与次年是否继续接受疾病调整疗法有关。","authors":"Elizabeth S. Gromisch , Aaron P. Turner , Steven L. Leipertz , John Beauvais , Jodie K. Haselkorn","doi":"10.1016/j.msard.2024.106179","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>It is recommended that healthcare providers and persons with multiple sclerosis (MS) have discussions prior to discontinuing a disease modifying therapy (DMT). However, if these appointments missed, either as a no show (NS) or short-notice cancellation (SNC), these discussions do not take place and may result in premature discontinuation. This study aimed to explore whether appointment non-attendance was predictive of DMT persistence the following year.</div></div><div><h3>Methods</h3><div>Electronic health record data from Veterans with MS (<em>n</em> = 3,742) in the Department of Veterans Affairs (VA) MS Center of Excellence Data Repository were examined during two time frames: January 2013 – December 2013 (Year 1) and January 2014 – December 2014 (Year 2). DMT non-persistence was defined as discontinuing a DMT and not restarting another one within 90 days. The proportion of each type of missed appointment in Year 1 was calculated by dividing the number of NS and SNC by the total number of scheduled appointments during that time frame, respectively. Logistic regressions were run for each appointment non-attendance behavior, with Year 2 non-persistence as the outcome and age, sex, race, number of comorbidities, time since initial DMT, and Year 1 non-persistence as covariates.</div></div><div><h3>Results</h3><div>Veterans who were non-persistent in Year 2 (<em>n</em> = 563) had a higher proportion of NS (6.5 % vs. 4.6 %, <em>p</em> < .001) and SNC (6.7 % vs 5.7 %, <em>p</em> = .002) in Year 1. After adjusting for demographics and DMT history, both the proportion of NS (<em>aOR</em> = 5.01, 95 % CI: 1.82, 13.29, <em>p</em> = .001) and SNC (<em>aOR</em> = 3.86, 95 % CI: 1.09, 12.90, <em>p</em> = .032) in Year 1 were significantly associated with non-persistence the following year.</div></div><div><h3>Conclusions</h3><div>Appointment non-attendance was associated with DMT non-persistence the following year, with both higher proportions of NS and SNC being significant contributors after controlling for demographics and DMT history. These findings highlight the potential effects of disruption to care for persons with MS.</div></div>","PeriodicalId":18958,"journal":{"name":"Multiple sclerosis and related disorders","volume":"92 ","pages":"Article 106179"},"PeriodicalIF":2.9000,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Appointment non-attendance is associated with disease modifying therapy persistence the following year\",\"authors\":\"Elizabeth S. Gromisch , Aaron P. Turner , Steven L. Leipertz , John Beauvais , Jodie K. Haselkorn\",\"doi\":\"10.1016/j.msard.2024.106179\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>It is recommended that healthcare providers and persons with multiple sclerosis (MS) have discussions prior to discontinuing a disease modifying therapy (DMT). However, if these appointments missed, either as a no show (NS) or short-notice cancellation (SNC), these discussions do not take place and may result in premature discontinuation. This study aimed to explore whether appointment non-attendance was predictive of DMT persistence the following year.</div></div><div><h3>Methods</h3><div>Electronic health record data from Veterans with MS (<em>n</em> = 3,742) in the Department of Veterans Affairs (VA) MS Center of Excellence Data Repository were examined during two time frames: January 2013 – December 2013 (Year 1) and January 2014 – December 2014 (Year 2). DMT non-persistence was defined as discontinuing a DMT and not restarting another one within 90 days. The proportion of each type of missed appointment in Year 1 was calculated by dividing the number of NS and SNC by the total number of scheduled appointments during that time frame, respectively. Logistic regressions were run for each appointment non-attendance behavior, with Year 2 non-persistence as the outcome and age, sex, race, number of comorbidities, time since initial DMT, and Year 1 non-persistence as covariates.</div></div><div><h3>Results</h3><div>Veterans who were non-persistent in Year 2 (<em>n</em> = 563) had a higher proportion of NS (6.5 % vs. 4.6 %, <em>p</em> < .001) and SNC (6.7 % vs 5.7 %, <em>p</em> = .002) in Year 1. After adjusting for demographics and DMT history, both the proportion of NS (<em>aOR</em> = 5.01, 95 % CI: 1.82, 13.29, <em>p</em> = .001) and SNC (<em>aOR</em> = 3.86, 95 % CI: 1.09, 12.90, <em>p</em> = .032) in Year 1 were significantly associated with non-persistence the following year.</div></div><div><h3>Conclusions</h3><div>Appointment non-attendance was associated with DMT non-persistence the following year, with both higher proportions of NS and SNC being significant contributors after controlling for demographics and DMT history. These findings highlight the potential effects of disruption to care for persons with MS.</div></div>\",\"PeriodicalId\":18958,\"journal\":{\"name\":\"Multiple sclerosis and related disorders\",\"volume\":\"92 \",\"pages\":\"Article 106179\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2024-11-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Multiple sclerosis and related disorders\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2211034824007557\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Multiple sclerosis and related disorders","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2211034824007557","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Appointment non-attendance is associated with disease modifying therapy persistence the following year
Background
It is recommended that healthcare providers and persons with multiple sclerosis (MS) have discussions prior to discontinuing a disease modifying therapy (DMT). However, if these appointments missed, either as a no show (NS) or short-notice cancellation (SNC), these discussions do not take place and may result in premature discontinuation. This study aimed to explore whether appointment non-attendance was predictive of DMT persistence the following year.
Methods
Electronic health record data from Veterans with MS (n = 3,742) in the Department of Veterans Affairs (VA) MS Center of Excellence Data Repository were examined during two time frames: January 2013 – December 2013 (Year 1) and January 2014 – December 2014 (Year 2). DMT non-persistence was defined as discontinuing a DMT and not restarting another one within 90 days. The proportion of each type of missed appointment in Year 1 was calculated by dividing the number of NS and SNC by the total number of scheduled appointments during that time frame, respectively. Logistic regressions were run for each appointment non-attendance behavior, with Year 2 non-persistence as the outcome and age, sex, race, number of comorbidities, time since initial DMT, and Year 1 non-persistence as covariates.
Results
Veterans who were non-persistent in Year 2 (n = 563) had a higher proportion of NS (6.5 % vs. 4.6 %, p < .001) and SNC (6.7 % vs 5.7 %, p = .002) in Year 1. After adjusting for demographics and DMT history, both the proportion of NS (aOR = 5.01, 95 % CI: 1.82, 13.29, p = .001) and SNC (aOR = 3.86, 95 % CI: 1.09, 12.90, p = .032) in Year 1 were significantly associated with non-persistence the following year.
Conclusions
Appointment non-attendance was associated with DMT non-persistence the following year, with both higher proportions of NS and SNC being significant contributors after controlling for demographics and DMT history. These findings highlight the potential effects of disruption to care for persons with MS.
期刊介绍：
Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource.
A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.
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