Treatment adherence and unmet needs at hospital pharmacy for the care of Spanish patients with multiple sclerosis

Objective To assess unmet needs at hospital pharmacies and treatment adherence of patients with multiple sclerosis (MS) treated with disease-modifying therapies (DMTs). Methods A non-interventional and multicentre study involving 24 pharmacies that included 237 patients with relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS) treated with DMTs. Pharmacists completed a questionnaire on management and needs. Adherence was assessed using the Morisky-Green test. Results The mean age of patients was 40.1 +/- 9.4 years (65.8% women). The average time from diagnosis was 7.5 +/- 5.6 years, 95.4% had RRMS and 61.2% had no relapses during the last year. Most patients (62.4%) had Expanded Disability Status Scale grade 0-2.5. Overall adherence was 77.1%. Treatment adherence was significantly higher among patients with no relapses (82.9% vs 67.4%, p<0.05) and among those >= 40 years old (85.1% vs 68.3%, p<0.05). 21.1% of pharmacies did not have adequate educational materials and in 16% of cases there was no proper space to assure confidentiality. A specific protocol to monitor adverse events only existed in 21% of pharmacies and to monitor adherence in 32%. Major unmet needs for pharmacists were educational materials, adherence training, staff shortages and increased workload. There was a trend towards lower adherence at hospitals with a higher workload (68.6% vs 80.2%) and with a lack of educational materials (75.2% vs 84.6%). In 19.8% of cases there was a discrepancy between pharmacist perception of adherence and the Morisky-Green test. Conclusions It is necessary to improve educational materials and operational protocols regarding workload at hospital pharmacies to provide adequate follow-up and to ensure adherence by Spanish patients with MS.