Factors associated with therapeutic inertia among pharmacists caring for people with multiple sclerosis

Maria A Terzaghi; Cedrik Ruiz; Iciar Martínez-López; Montserrat Pérez-Encinas; Fabien Bakdache; Jorge Maurino; Gustavo Saposnik

doi:10.1016/j.msard.2019.101887

Factors associated with therapeutic inertia among pharmacists caring for people with multiple sclerosis

Mult Scler Relat Disord. 2020 Apr:39:101887. doi: 10.1016/j.msard.2019.101887. Epub 2019 Dec 9.

Authors

Maria A Terzaghi¹, Cedrik Ruiz¹, Iciar Martínez-López², Montserrat Pérez-Encinas³, Fabien Bakdache⁴, Jorge Maurino⁵, Gustavo Saposnik⁶

Affiliations

¹ Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Canada.
² Department of Pharmacy, Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain.
³ Department of Pharmacy, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
⁴ Medical Affairs, Neuroscience, Hoffmann-La Roche Limited, Mississauga, Canada.
⁵ Medical Department, Roche Pharma, Madrid, Spain.
⁶ Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Canada; Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto, Canada; Laboratory for Social and Neural Systems Research, Department of Economics, University of Zurich, Switzerland. Electronic address: saposnikg@smh.ca.

PMID: 31846865
DOI: 10.1016/j.msard.2019.101887

Abstract

Introduction: Pharmacists play a critical role on therapeutic decisions in multiple sclerosis (MS) care. Therapeutic inertia (TI) is defined as the lack of treatment initiation or escalation when there was evidence of clinical and radiological disease activity. The aim of this study was to assess factors associated with TI among pharmacists involved in MS care.

Methods: A multicenter, non-interventional, cross-sectional study involving hospital pharmacists in Spain was conducted. Participants answered questions regarding their standard practice, risk preferences, and management of nine simulated MS case-scenarios. We created a score defined as the number of case-scenarios that fit the TI criteria over the total number of presented cases (score range from 0-6). Similarly, an optimal treatment score (OTS) was created to determine the degree of appropriate pharmacological decisions (ranging from 0-lowest to 9-highest). Candidate predictors of TI included demographic data, practice setting, years of practice, MS expertise, number of MS patients managed at hospital/year, participation in MS clinical trials, and participants' risk preferences.

Results: Overall, 65 pharmacists initiated and completed the study (response rate: 45.5%). The mean age was 43.5 ± 7.8 years and 67.1% were female. Forty-two (64.6%) participants had specialization in MS management. Overall, the mean TI score was 3.4 ± 1.1. Of 390 individual responses, 224 (57.4%) met the TI criteria. All participants failed to recommend treatment escalation in at least one of the six case-scenarios. The mean OTS was 4.1 ± 1.4. Of 585 individual responses, 264 (45.1%) met the optimal choice criteria. Only 40% of participants (23/65) made five or more optimal treatment choices. Lower experience in dispensing MS drugs and lack of specialization in MS were the most common factors associated with TI and optimal management. The multivariable analysis revealed that more years of experience (p = 0.03), being a co-author of a peer-reviewed publication (p = 0.03), and specialization in MS (p = 0.017) were associated with lower TI scores (adjusted R² = 0.23).

Conclusion: Therapeutic inertia was observed in all pharmacist participants, affecting over fifty percent of MS treatment choices. Continuing education and specialization in MS may facilitate therapeutic decisions in MS care.

Keywords: Decision-making; Disease-modifying therapy; Inertia; Multiple sclerosis; Pharmacists.