CP10
Behavioral Medicine in Multiple Sclerosis: What Determines Who Receives Services?
A recent literature review found strong evidence that stress was linked with the onset of multiple sclerosis (MS) or relapse of symptoms (Artemiadis, Anagnostouli, & Alexopoulos, 2011). Cognitive, emotional, and behavioral reactions to diagnosis and disease progression were also predictive of illness-related functional impairment (Dennison et al., 2010). Furthermore, there is evidence that for patients with MS, emotional distress, such as depression or anxiety, fatigue, and quality of life are all reciprocally related with disease progression (Pittion-Vouyovitch et al., 2006). The disease progression of MS was also associated with other physiological changes including autonomic dysfunction (Flachenecker et al., 2001). However, several mind-body interventions such as exercise, cognitive-behavior therapy, relaxation, and stress management were beneficial for patients with relapsing-remitting MS (RRMS) to improve stress, locus of control, and emotional distress (Artemiadis et al., 2012), quality of life (Sung et al., 2013), fatigue (van Kessel et al., 2008), and the occurrence of new brain lesions (Mohr, 2012).
Since 2010, over eight thousand individual patients with MS have been treated at the Mellen Center for Multiple Sclerosis at the main campus of the Cleveland Clinic. Hundreds of these patients have been referred to receive services from behavioral medicine (BM) for issues including: emotional distress such as depression or anxiety; improving coping skills; adjustment to, and acceptance of, diagnosis with MS; and increasing quality of life. Despite the large number of patients with MS who are seen, the decision of which patients are referred to receive services remains unclear. The role of patient-specific characteristics (e.g., age, disease course, race, insurance, previous psychiatric diagnosis) as well as referring provider characteristics may both play a role in determining which patients are referred to receive services and could be evaluated to optimize the referral process.
Objectives: To evaluate factors which contribute to the amount of time passed until patients are seen by BM.
Methods:
Data was retrospectively gathered for 8,235 patients with MS seen at the Mellen Center for Multiple Sclerosis at the main campus of the Cleveland Clinic Foundation in Cleveland, Ohio between 01/01/2010 and 12/18/2014. Although IRB approval has been received and data has been acquired, data analyses are not yet complete. Planned data analyses involve using time-to-event survival analysis looking at the time since first neurology appointment at the Mellen Center until first BM appointment as primary outcome of interest. Kaplan-Meier curves will be used to illustrate patterns in time until BM appointment.
Results:
Data analyses not yet complete but will be by date of conference.
Conclusions:
Data analyses not yet complete but will be by date of conference.