Highlights
- •Therapeutic inertia is a well-known phenomenon in multiple sclerosis that may lead to poorer clinical outcomes, including greater disability and lower quality of life.
- •Pharmacists are increasingly playing a critical role in the multidisciplinary management of multiple sclerosis. In this study using a behavioral economics approach, all pharmacists failed to recommend treatment escalation despite clinical and radiological evidence of a suboptimal disease activity control.
- •Specialization in MS, more years of experience in dispensing disease-modifying therapies, and being a co-author of a peer-reviewed publication were associated with a lower likelihood of therapeutic inertia among pharmacists. Tolerance to uncertainty and willingness to take risks in different domains were not associated with TI.
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
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Article info
Publication history
Published online: December 09, 2019
Accepted:
December 7,
2019
Received in revised form:
December 1,
2019
Received:
September 2,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
