Promoting Multiple Sclerosis Medication Adherence through Telehealth

Friday, May 29, 2015
Griffin Hall
Jill R Settle, MA , Washington, DC VAMC, MS Center of Excellence, Washington, DC
Zipporah Miles, BA , Washington, DC VAMC, MS Center of Excellence, Washington, DC
Heidi W Maloni, PhD , Washington, DC VAMC, MS Center of Excellence, Washington, DC
McKenzie E Bedra, MPH , Johns Hopkins University, Baltimore, MD
Joseph Finkelstein, MD, PhD , Johns Hopkins University, Baltimore, MD
Mitchell T Wallin, MD, MPH , Washington, DC VAMC, MS Center of Excellence, Washington, DC


MS DMTs have been available for more than 20 years; however, adherence to a DMT regimen is often poor. The most common reason is forgetting to take medications on the specific day they are to be administered. The Home Automated Telehealth system has been successfully implemented in other chronic diseases including asthma, hypertension, and inflammatory bowel disease.


The primary aim of this study was to establish the feasibility of implementing a home telehealth program to support and monitor MS medication adherence without increasing healthcare provider burden.


We addressed the assessment of poor adherence using a comprehensive Home Automated Telemanagement system for MS (MS HAT).  MS HAT is a home-based internet module that supports patient self-management, patient-provider communication, and patient education. For approximately six months, thirty participants were randomized to either MS HAT or treatment as usual. All participants stored their interferon beta 1a syringes (IB1a) in a clear syringe container and maintained a paper calendar of IB1a adherence. Pharmacy refill rates were also collected from medical records. Participants in the MS HAT condition received text or email reminders to administer their medications.


There were no significant differences in demographic variables between the two groups. Likewise, adherence did not significantly differ between the two groups. IB1a MS HAT alert rates were negatively correlated with syringe counts, r=0.61, p=.026. As alerts decreased, syringes collected increased. Syringe count was positively related to change in Morisky score for interferon beta 1a, r=0.60, p=.002. As self-reported adherence improved, the number of syringes collected also increased. Pharmacy refills of IB1a were directly related to calendar reports of taking IB1a, r=0.52, p=.040, and syringe counts r=0.69, p<.001. As pharmacy refills increased, so did calendar report and syringes collected.


The strong correlations between self-report and objective measures of adherence suggest that self-reported monitoring through an automated telehealth mechanism, such as MS HAT, can provide a valid assessment of DMT adherence. Importantly, utilizing an automated electronic system reduces the time spent making phone calls and researching pharmacy refill records by healthcare providers.