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Nurses offer line of defense in MS nonadherence

Nurses are well-positioned to address medication nonadherence, which is a common concern when treating multiple sclerosis, according to a presentation at the 2015 Annual Meeting of the Consortium of Multiple Sclerosis Centers, held May 27–30 in Indianapolis.

Nonadherence leads to more inpatient stays and higher medical costs, while careful adherence to disease-modifying therapy (DMT) is associated with better function and quality of life, said Megan Weigel, DNP, ARNP-C, MSCN of Baptist Neurology in Jacksonville Beach, FL.

Patients with MS are likely to encounter factors that influence nonadherence in general, such as side effects or injection anxiety. However, other barriers may be related to the nature of this particular disease or its treatments, she noted.

Patients may hold inaccurate expectations for a DMT, such as that it will cure their disease or reverse symptoms. Conversely, they may stop taking medications when their disease stabilizes or symptoms resolve.

Mood and cognitive disturbances common to MS can also reduce patients’ odds of adherence, she noted. A 2010 study found that MS patients with a current mood or anxiety disorder were roughly five times more likely to have difficulty adhering to DMT than MS patients without a psychiatric diagnosis. In 2009, a study of MS patients on injection DMT found that the top reason for missing doses was forgetfulness. [1,2]

In their role as educators, nurses can reduce the risk of nonadherence by helping patients set appropriate expectations for their therapy. Also, when they anticipate barriers to injection therapy – such as reduced dexterity and decreased vision – nurses can discuss solutions ahead of time, Dr. Weigel said.

In addition, nurses can also catch early signs of nonadherence. “Perhaps I get a fax from a third-party pharmacy that says the patient is two weeks late filling her disease-modifying therapy, so I call her and ask ‘What’s going on?’ The patient is usually surprised,” she said. “But it opens the door to a conversation where I say, ‘If something is going on with your disease modifying therapy that’s affecting you, it’s important that we know about it so we can make a better choice for you.’ There’s no reason why a nurse would have to enlist a physician to have that conversation. That’s something that can very much be done at the nursing level.”

Bruce JM, Hancock LM. Treatment adherence in multiple sclerosis: association with emotional status, personality, and cognition. J Behav Med. 2010; 33(3): 219–27.

Treadaway K, Cutter G. Factors that influence adherence with disease-modifying therapy in MS. J Neurol. 2009; 256(4): 568–76.