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Multiple Sclerosis Center of Excellence West, Veterans Affairs, 1660 South Columbian Way, Seattle, WA 98108, USA; Rehabilitation Care Service, VA Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108, USA; Department of Rehabilitation Medicine, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA; Department of Epidemiology, University of Washington, 325 Ninth Avenue, Seattle, WA 98104, USA.
Published: December 2024
AI Article Synopsis
Article Abstract
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.
