Assessing the role of patient support services on adherence rates in patients using glatiramer acetate for relapsing-remitting multiple sclerosis

Figures & data

Table 1.  Chronic care model tenets adopted in the Shared Solutions model.

Chronic care model elements	Chronic care model critical success factors	Shared Solutions critical success factors
Health System Goal: Creating a culture, organization, and mechanisms that promote safe, high-quality care	• Visibly support improvement at all levels of the organization, beginning with the senior leader	XX
	• Promote effective improvement strategies aimed at comprehensive system change	XX
	• Encourage open and systematic handling of errors and quality problems to improve care^a	XX
	• Provide incentives based on quality of care
	• Develop agreements that facilitate care co-ordination within and across organizations^a	XX
Delivery System Goal: Assure the delivery of effective, efficient clinical care and self-management support	• Define roles and distribute tasks among team members	XX
	• Use planned interactions to support evidence-based care	XX
	• Provide clinical case management services for complex patients^a	XX
	• Ensure regular follow-up by the care team	XX
	• Give care that patients understand and that fits with their cultural background^a	XX
Decision Support Goal: Promote clinical care that is consistent with scientific evidence and patient preferences	• Embed evidence-based guidelines into daily clinical practice	XX
	• Share evidence-based guidelines and information with patients to encourage their participation	XX
	• Use proven provider education methods	XX
	• Integrate specialist expertise and primary care	–
Clinical Information System Goal: Organize patient and population data to facilitate efficient and effective care	• Provide timely reminders for providers and patients	XX
	• Identify relevant sub-populations for pro-active care	XX
	• Facilitate individual patient care planning	XX
	• Share information with patients and providers to co-ordinate care^a	XX
	• Monitor performance of practice team and care system
Self-Management Support Goal: Empower and prepare patients to manage their health and healthcare	• Emphasize the patient’s central role in managing their health	XX
	• Use effective self-management support strategies that include assessment, goal-setting, action planning, problem-solving, and follow-up	XX
	• Organize internal and community resources to provide ongoing self-management support to patients	XX
The Community Goal: Mobilize community resources to meet needs of patients	• Encourage patients to participate in effective community programs	XX
	• Form partnerships with community organizations to support and develop interventions that fill gaps in needed services
	• Advocate for policies to improve patient care^a

XX reflects attributes of the Chronic Care Model that are foundational to the design and operations of the Shared Solutions program; ^a Reflects attributes included in the 2003 updated version of the Chronic Care Model (http://www.improvingchroniccare.org/index.php?p=Model_Elements&s=18).

Table 2.  Percentage of patients reaching 80% adherence (MPR) goal.

	MPR < 80% (n = 1495)	MPR ≥ 80% (n = 4330)	Total study population (n = 5825)	p-value^a
Age (mean; SD)	46.93 (12.95)	46.23 (12.17)	44.40 (10.14)	0.943
Percentage of patients receiving Teva-provided injection training, n (%)
Training not provided	562 (31.6%)	1215 (28.1%)	1777 (30.5%)	<0.001*
One Teva-provided injection training session	794 (53.1%)	2629 (41.5%)	3423 (58.8%)
≥Two Teva-provided injection training sessions	139 (22.2%)	486 (8.3%)	625 (10.7%)
Percentage of patients re-starting glatiramer treatment*
Glatiramer Acetate Naive	1358 (24.7%)	4137 (75.3%)	5495 (94.3%)	<0.001*
Glatiramer Acetate Restart	137 (41.5%)	193 (58.5%)	330 (5.7%)
Number of Shared Solutions nursing contacts (24 months)
One	686 (11.8%)	1983 (34.0%)	2669 (45.8%)	0.017*
Two or Three	560 (9.6%)	1483 (25.5%)	2043 (35.1%)
Four	91 (1.6%)	292 (5.0%)	383 (6.6%)
≥Five	158 (2.7%)	572 (9.8%)	730 (12.5%)
Eligible and accessed co-payment assistance
No	251 (4.3%)	593 (10.2%)	844 (14.5 %)	<0.001*
Yes	1244 (21.4%)	3737 (64.2%)	4981 (85.5%)

MPR, medication possession ration, n, number of patients, SD, standard deviation.

*Statistically significant difference at 0.05 level.

^aCategorical variables were compared using chi-squared tests. Continuous variables were compared using Student t-tests.

Table 3.  Predictors of attainment of 80% adherence goal.^a

Potential contributing factors	Odds ratios (95% CI)	p-values^b
Age	1.024 (1.018–1.030)	<0.001*
Teva-provided injection training*	1.435 (1.258–1.636)	<0.001*
Glatiramer acetate restart^a	0.605 (0.476–0.769)	<0.001*
Patient utilizing co-payment assistance^b	1.306 (1.109–1.570)	0.001*
Greater than once encounter with Shared Solution’s nurses
Two or three encounters within 24 months	0.880 (0.771–1.005)	0.003*
Four encounters within 24 months	1.019 (0.790–1.314)	0.061
≥Five encounters within 24 months	1.125 (0.921–1.374)	0.70

CI, Confidence Interval.

*Statistically significant difference at p = 0.05.

^aResults of logistic regression model with dichotomous independent variable with 1 = attainment of adherence goal of 90% or greater; 0 = otherwise. Dependent variables included patient age, Teva-provided injection training* (1 = yes; 0 = no training provided), patient restarting glatiramer acetate^a (1 = yes, patient had been on glatiramer acetate previous to their enrollment in the Shared Solutions program; 0 = patient had not been on glatiramer acetate prior to their enrollment), copayment assistance^b provided (1 = yes; 0 = did not participate in the program) and number of encounters with shared solutions nurse relative to a single encounter. ^bp-values derived from the logistic regression model Wald Chi-squared values.