The Role of a Hospital Pharmacist in Managing Multiple Sclerosis

Pharmacists can enhance their role in the multidisciplinary management of multiple sclerosis (MS) by understanding treatment characteristics that are more meaningful in a hospital setting, according to a paper published in the journal Pharmacy.

Investigators from Spain started by conducting a focus group with 6 hospital pharmacists to gather their thoughts on the main attributes of disease-modifying therapies (DMT) efficacy. These hospital pharmacists play a continually increasing role in managing MS patients’ care, the study authors explained, though little is known about their preferences and perspectives towards these therapies.

“They are involved in drug dispensation, patient education, management of adverse reactions or follow-up support, and treatment adherence evaluation,” the study authors wrote. “However, there are no data on their preferences for different attributes of MS treatments.”

After the focus group discussion, the investigators focused on measuring preventing relapses, delaying disease progression, controlling radiological activity, and preserving health-related quality of life (HRQoL) and cognition, they reported.

Then, for their larger study, the investigators conducted a web-based study of 65 hospital pharmacists to assess their preferences. Nearly two-thirds of the participants were female, the study authors learned, and the mean age was 45 years. The participants were asked to rank scenarios from 1, being the most preferred, to 8, being the least preferred. The investigators also stratified the data to create consistent levels of demographic characteristics, experience, research background, and volume of patients seen per year across the cohort.

The investigators found that the pharmacists placed the greatest relative importance on delaying disease progression (35%), followed by preserving HRQoL (21%), and cognition (21%), they said. The investigators also learned that pharmacists with a longer experience in DMTs seemed to have slightly higher preferences for treatments with better efficacy based on their disease progression, cognition, and control of radiological activity.

The study authors finally conducted an exploratory cluster analysis to determine any possible profiles based on preferences for attributes, and broke up the participants into 3 categories based on the importance assigned to each attribute:

1. Cluster 1: The 14 participants in this group preferred MS treatments with low impact on HRQoL and slightly higher importance of preventing relapse.
2. Cluster 2: 15 participants preferred MS treatments that preserved cognition.
3. Cluster 3: A majority of the participants (36) preferred MS treatments that delayed disease progression and controlled radiological disease activity.

The study authors wrote that measuring the differences of opinion among health care professionals regarding intervention attributes is crucial for the design and evaluation of existing and new therapies. They added that incorporating these values in the decision-making policy can result in clinical, licensing, reimbursement, and policy decisions that better reflect preferences of each stakeholder along the way. But measures that assess DMT attributes need to be improved, they said.

“Given the growing relevance of value-based clinical decision-making in current health systems, the important role of hospital pharmacists in managing therapeutic options in diseases with a wide range of treatments, and the lack of studies that consider their point of view, this study provides an additional and novel perspective on the management of DMTs for relapsing-remitting MS,” the study authors concluded. “Understanding which treatment characteristics are meaningful to pharmacists may help to enhance their synergistic role in the multidisciplinary management of patients with MS.”

Reference

Martinez-LopezI, Maurino J, Sanmartin-Fenollera P et al Assessing pharmacists’ preferences towards efficacy attributes of disease-modifying therapies in relapsing-remitting multiple sclerosis. Pharmacy. 2020;8(2), 61; doi: 10.3390/pharmacy8020061.