Comparison of Strategic Methodologies - Essay Example

 Comparison of Strategic methodologies for the Improvement of Regimen Compliance for Multiple Sclerosis patients. Numerous therapies exist to improve the symptoms and delay the onset of multiple sclerosis; A chronic, inflammatory demyelinating auto-immune disorder affecting myelin sheaths of the central nervous system. The essential goals of therapy are to return function following an attack, as well as preventing both disability from attacks, and to stop new exacerbations from occurring. These attacks most commonly take the form of the relapsing-remitting subtype. This is often defined by unpredictable relapse-attacks interspersed with periods of remission with few indications of the disease. Even without the acute attacks, over the course of several years, sufferers of this subtype can expect a decrease in neurological ability. A more rare, Progressive-Relapsing form includes these attacks but with progressive neurological decline from the very first onset of the disease. (National Multiple Sclerosis Society, 2011) A decline in neurological function with - or without exacerbations may be diagnosed as Secondary Progressive Multiple Sclerosis. (Jones, 2011) As a life-long, chronic condition, patients must adapt to the need to continuously, regularly maintain a treatment protocol. Even where treatment is available and affordable, the presence of side-effects is one of many motivations for the development of yet more possible therapies still under investigation. The purpose of this discussion is to compare strategies for increasing patient adherence to treatment regimens; in that regard it is worthwhile to understand barriers to regimen compliance. Since 2006, developments in drug therapy create a probability of reducing acute attacks by as much as 90%, making the question of whether or not a patient complies with treatment a difference between employment or convalescence. The below example dramatically illustrates the potency of some of the treatment options presently available: “Dr. Boggild started treating with Karen Ayres, 28, in 2002. Karen Ayres has MS. Since 2002 she has not suffered any relapses at all. Ayres said she came to see Dr. Boggild during her second relapse. She was unable to walk or feed herself - she was barely able to wave her hand. A few weeks after treatment started she walked out of the rehab centre unaided. She says that since the beginning of this treatment she has managed to lead a completely normal life - she has travelled to five continents and is currently doing a PhD in Psychology at Leeds University, UK.” (Nordqvist, 2006) Certain cancer treatment drugs have been adapted in recent years, in combination with the fruits of dedicated clinical research. Mitoxantrone, normally used for treatment of Metastatic breast cancer, and non-Hodgekin’s Lymphoma can be combined with slow-acting Copaxone, in this case for a dramatic result. (Nordqvist, 2006) (Parker et al. 2010) Nonetheless, a variety of complications can arise during the course of patient treatment that may generate difficulties with treatment compliance. Compliance issues with injection therapies; age: in some cases, adolescence is a difficult period in terms of patient compliance; denial of the disease or of its severity - leading to resistance; insufficient comprehension of the need for treatment: If symptoms should abate, the necessity for continuation of the treatment regimen will seem doubtful to certain patients. "One of the most common causes of a poor response is simply not taking medications the right way," According to Jack S. Burks, MD Chief Medical Officer of the Multiple Sclerosis Association of America. Physicians will emphasis that it is imperative patients not cease taking treatments even if they believe they are not seeing results. Some medications slow progression of the disease severity, but may not control symptoms, the many classes of drugs have different roles. (Lava, 2011) Other challenges in compliance can be a decline in personal confidence in their physician; possibly leading to semi-illegal 'doctor-shopping'. On the psychological front, some patients report a superstitious certainty of deservedness, or fate concerning their affliction. Other issues facing MS patients may include simple treatment fatigue. More worrisome are memory-problem side-effects, cognitive deficits, including memory loss. (Chiovetti, et al. 2006) These worrisome deficiencies typically constitute the secondary illness progressions outside of the obvious, acute exacerbations. Is the best means of compliance a strategy that promotes an apparatus of social support; are simple, mail-in surveys enough to provide and accurate indicator of compliance? A recent study from the Journal of Internet Research (2011) employed online surveys, The Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ) to provide relevant data in terms of test compliance with prescribed drug treatment regimens. (Wicks et al. 2011) Of the 35.7% that responded, evidence indicated that social coping strategies appear to be more important in terms of adherence than any interfering demographic or clinical manifestation. But this study may itself not prove sufficiently representative with less than a majority of patients choosing to respond. But one might infer that the lack of compliance with the survey may negatively impact compliance in other areas as well. Recommended Coping strategies created a negative correlation with the measurement of missed therapeutic doses. So clearly, a social support mechanism makes patients noticeably more likely to take the necessary treatment on time, when it will prove effective. MS education may prove more challenging than with deficiencies strictly in terms of motor function, due to the possibility of memory impairment; requiring specialized nurse-patient partnerships, as described in the strategy for overcoming barriers to treatment regimen commitment. In regards to the simplest option, the strategy involving the patient multiple-choice survey, that method is likely to produce discrepancies. The idea to provide financial compensation in return for the completion of the survey is theoretically logical. It is certainly not unheard of for clinical study participants to receive monetary incentives for their participation; usually in research phases before actual drug approval. The amount in this case should be enough to make study adherence worth the patient's time, yet not so much that people will be tempted to participate in the study fraudulently just to secure the funds. For this survey, a principal issue is not whether the dollar amount is too little, but there is simply, a security factor to consider: Businesses that solicit payments from customer via physical mail routinely advise their customers to not send actual cash through the mail; the risks are unavoidable. To permit the incentive, yet ensure security of the payments; at the time of diagnosis, arrangements should be made to automatically deposit funds into a bank account upon completion of the survey online; or upon receipt of the returned envelope if the patient is without internet access and delivers the survey through regular mail. The survey sheet needs to be reconsidered, and as a compliance/research strategy by itself, it is insufficient. With measures taken to secure the compensation offered, it would be useful to supplement one of the other two strategies. As for the other two proposals, the article entitled, “Significant Barriers Prevent People with MS from Fully Committing to Treatment Regimen” describes the challenges and misconception facing MS patients, and calls for stronger partnerships with healthcare professionals; MS nurses to grant the social support needed. The second proposal: TERTIARY PREVENTION OF MULTIPLE SCLEROSIS: Improving MS Care, provides a factual outline of the issues, and attempts to answer the question of whether social support improves treatment adherence. IT then suggests two possible psychological therapeutic models without firm commitment, or definitive exploration of either. There is mention of the ‘Health Belief Model’ and the ‘Transtheoretical Model’. It gives minimal descriptions of the implementations of both, but does not identify the superiority of one approach over the other. Must both approaches be implemented simultaneously? Should there be variation, should HBM be used preferentially in some cases, and the Transtheoretical approach used in others? While there are no clearly, 'bad', or unproductive recommendations in the 'Improving MS care' article, it does not constitute a definitive call to action. The 'Barriers' article on the other hand, gives more detail on support and encouragement, with more specific recommendations to action. It gives direction for addressing the problem, from the first diagnosis of the disease, rather than simply implying that the problem exists while giving a non-committal suggestion for one of two possible actions. The issues are defined, challenges described, and it begins by issuing a proposal for action. It is more forward thinking and direct. The ‘Improving MS care’ first attempts to prove that an issue exists, and that social support will help alleviate it. The ‘Barriers’ article begins with the premise of improving the compliance – or lack – thereof with a specific call to action. Therefore, “Significant Barriers Prevent People with MS from Fully Committing to Treatment Regimen” should be given more credence and support. Either proposal could be enhanced by the compliance survey, but only after more secure payment arrangements are made. REFERENCES Chiovetti A. Bridging the gap between health literacy and patient education for people with multiple sclerosis. J Neurosci Nurs. 2006 Oct;38(5):374-8. PubMed PMID: 17069267. Parker C, Waters R, Leighton C, Hancock J, Sutton R, Moorman AV, Ancliff P, Morgan M, Masurekar A, Goulden N, Green N, Révész T, Darbyshire P, Love S, Saha V (2010). "Effect of mitoxantrone on outcome of children with first relapse of acute lymphoblastic leukaemia (ALL R3): an open-label randomised trial". Lancet 376 (9757): 2009–2017. doi:10.1016/S0140-6736(10)62002-8. PMC 3010035. PMID 21131038. National Multiple Sclerosis Society. What We Know About Progressive-Relapsing MS (PRMS) Accessed 6/29/2011. http://www.nationalmssociety.org/about-multiple-sclerosis/progressive-ms/progressive-relapsing-ms/index.aspx Nordqvist, Christian. 2006. New Multiple Sclerosis Treatment Reduces Relapse Rate By 90%. Medical News Today. http://www.medicalnewstoday.com/articles/47895.php Jones, Paul. 2011. Mult-sclerosis.org All About Multiple Sclerosis. Last Accessed 6/29/2011. Last Modified: 06/25/2011 09:51:44. http://www.mult-sclerosis.org/ Lava, Neil. MD. 2011. Is Your MS Treatment Working? WebMD Feature. Reviewed on April 28, 2011. Accessed 6/29/2011. http://www.webmd.com/multiple-sclerosis/features/ms-care-team Wicks P, Massagli M, Kulkarni A, Dastani H. Use of an online community to develop patient-reported outcome instruments: the Multiple Sclerosis Treatment Adherence Questionnaire (MS-TAQ). J Med Internet Res. 2011 Jan 24;13(1):e12. PubMed PMID: 21266318. Read More