Contributions
Abstract: P1216
Type: Poster
Abstract Category: Therapy - disease modifying - Long-term treatment monitoring
Introduction: A 2015 consensus report1 highlights the need to improve the quality of diagnosis, treatment and monitoring in multiple sclerosis (MS).
Methods: We present a quality improvement (QI) approach in MS informed by action effect (AE) methodology,2 and data that illustrate the need to improve: A) Time to diagnosis, B) Treatment optimization, C) Quality standards. A) MS patients ≤5 years from diagnosis in 8 Western European countries retrospectively reported time from first symptoms to diagnosis.3 B) Data on switching from a 1st line disease-modifying therapy (DMT) in Germany were obtained for: i) hospital outpatients with relapsing-remitting MS in 2010-2013 from a prospective study;4 ii) non-hospital-based MS patients in 2015 from pharmacist databases. DMTs were defined as 1st/2nd line based on European Medicine Agency indications. C) UK neurologists were surveyed by email in July 2015.
Results: The aim of the QI approach is to maximize lifelong brain health in MS patients and improve outcomes. An AE diagram presents interventions, contributing factors and measure concepts for diagnosis, treatment, and monitoring.
New data that support the need for QI are: A) 49% of 2374 respondents reported being diagnosed ≤4 years from first symptoms; the mean (standard deviation) time was 8.64 (10.06) years. B) In Germany the proportions who switched from a 1st to a 2nd line DMT were: 37% of 1st- and 50% of 2nd-switch hospital outpatients (2010-13; n=278); 21% of 1st- and 22% of 2nd-switch non-hospital-based patients (2015; n>3500). C) Of the 49/115 UK neurologists who responded, the majority favoured including the following in a quality standard: MRI for diagnosis (38/49); DMT treatment rates (overall [33/49]; 2nd line [31/49]); MRI for monitoring (30/49).
Conclusions: There is room for improvement in time to diagnosis; clinical practice in treatment optimization varies widely; neurologists support a quality standard that incorporates DMT treatment rates and MRI for diagnosis and monitoring. These data support the need for QI in MS.
A QI approach aims to improve diagnosis, treatment and monitoring in order to maximize lifelong brain health in MS patients. It is informed by iterative AE methodology; engaging with the wider MS community, including patients, will be key to its success.
References:
1 Giovannoni et al. 2015;doi:10.21305/MSBH.001
2 Reed et al. BMJ Qual Saf 2014;23:1040-8
3 Kobelt, unpublished data
4 Vormfelde et al. JMIR Res Protoc 2016;doi:10.2196/resprot.4473
Disclosure: J Hobart has received consulting fees, honoraria, support to attend meetings or research support from Acorda, Asubio, Bayer Schering, Biogen Idec, Genzyme, Merck Serono, Novartis, Teva, Oxford PharmaGenesis and F. Hoffmann-La Roche.
M Alexander: nothing to disclose.
A Bowen: nothing to disclose.
H Butzkueven has received consulting fees from Genzyme, Biogen, Novartis, Merck and Oxford PharmaGenesis; and grant/research support from Biogen, Novartis, Merck and Genzyme.
G Giovannoni has received consulting fees from AbbVie, Bayer HealthCare, Biogen, Canbex Therapeutics, Five Prime Therapeutics, Genzyme-Sanofi, GlaxoSmithKline, GW Pharma, Merck, Merck Serono, Novartis, Protein Discovery Laboratories, Oxford PharmaGenesis, Roche, Synthon, Teva Neuroscience and UCB; and grant/research support from Bayer HealthCare, Biogen, Genzyme-Sanofi, Merck, Merck Serono and Novartis.
T Kenny has received consulting fees from AbbVie, Dune Business Consulting, Lilly, Matrix Policy Solutions, Quality Improvement Clinic, Shire and Spoonful of Sugar.
G Kobelt has received consulting fees from Biogen, Merck Serono, Novartis, Sanofi‐Genzyme, Teva and Oxford PharmaGenesis.
T Ziemssen has received personal compensation for participating on advisory boards, trial steering committees and data and safety monitoring committees, as well as for scientific talks and project support from: Bayer HealthCare, Biogen Idec, Elan, Genzyme, Merck Serono, Novartis, Roche, Sanofi-Aventis, Synthon and Teva.
Independent writing and editing assistance for the preparation of this abstract was provided by Oxford PharmaGenesis, Oxford, UK, funded by grants from AbbVie and Actelion Pharmaceuticals and an educational grant from Novartis, all of whom had no influence on the content.
Abstract: P1216
Type: Poster
Abstract Category: Therapy - disease modifying - Long-term treatment monitoring
Introduction: A 2015 consensus report1 highlights the need to improve the quality of diagnosis, treatment and monitoring in multiple sclerosis (MS).
Methods: We present a quality improvement (QI) approach in MS informed by action effect (AE) methodology,2 and data that illustrate the need to improve: A) Time to diagnosis, B) Treatment optimization, C) Quality standards. A) MS patients ≤5 years from diagnosis in 8 Western European countries retrospectively reported time from first symptoms to diagnosis.3 B) Data on switching from a 1st line disease-modifying therapy (DMT) in Germany were obtained for: i) hospital outpatients with relapsing-remitting MS in 2010-2013 from a prospective study;4 ii) non-hospital-based MS patients in 2015 from pharmacist databases. DMTs were defined as 1st/2nd line based on European Medicine Agency indications. C) UK neurologists were surveyed by email in July 2015.
Results: The aim of the QI approach is to maximize lifelong brain health in MS patients and improve outcomes. An AE diagram presents interventions, contributing factors and measure concepts for diagnosis, treatment, and monitoring.
New data that support the need for QI are: A) 49% of 2374 respondents reported being diagnosed ≤4 years from first symptoms; the mean (standard deviation) time was 8.64 (10.06) years. B) In Germany the proportions who switched from a 1st to a 2nd line DMT were: 37% of 1st- and 50% of 2nd-switch hospital outpatients (2010-13; n=278); 21% of 1st- and 22% of 2nd-switch non-hospital-based patients (2015; n>3500). C) Of the 49/115 UK neurologists who responded, the majority favoured including the following in a quality standard: MRI for diagnosis (38/49); DMT treatment rates (overall [33/49]; 2nd line [31/49]); MRI for monitoring (30/49).
Conclusions: There is room for improvement in time to diagnosis; clinical practice in treatment optimization varies widely; neurologists support a quality standard that incorporates DMT treatment rates and MRI for diagnosis and monitoring. These data support the need for QI in MS.
A QI approach aims to improve diagnosis, treatment and monitoring in order to maximize lifelong brain health in MS patients. It is informed by iterative AE methodology; engaging with the wider MS community, including patients, will be key to its success.
References:
1 Giovannoni et al. 2015;doi:10.21305/MSBH.001
2 Reed et al. BMJ Qual Saf 2014;23:1040-8
3 Kobelt, unpublished data
4 Vormfelde et al. JMIR Res Protoc 2016;doi:10.2196/resprot.4473
Disclosure: J Hobart has received consulting fees, honoraria, support to attend meetings or research support from Acorda, Asubio, Bayer Schering, Biogen Idec, Genzyme, Merck Serono, Novartis, Teva, Oxford PharmaGenesis and F. Hoffmann-La Roche.
M Alexander: nothing to disclose.
A Bowen: nothing to disclose.
H Butzkueven has received consulting fees from Genzyme, Biogen, Novartis, Merck and Oxford PharmaGenesis; and grant/research support from Biogen, Novartis, Merck and Genzyme.
G Giovannoni has received consulting fees from AbbVie, Bayer HealthCare, Biogen, Canbex Therapeutics, Five Prime Therapeutics, Genzyme-Sanofi, GlaxoSmithKline, GW Pharma, Merck, Merck Serono, Novartis, Protein Discovery Laboratories, Oxford PharmaGenesis, Roche, Synthon, Teva Neuroscience and UCB; and grant/research support from Bayer HealthCare, Biogen, Genzyme-Sanofi, Merck, Merck Serono and Novartis.
T Kenny has received consulting fees from AbbVie, Dune Business Consulting, Lilly, Matrix Policy Solutions, Quality Improvement Clinic, Shire and Spoonful of Sugar.
G Kobelt has received consulting fees from Biogen, Merck Serono, Novartis, Sanofi‐Genzyme, Teva and Oxford PharmaGenesis.
T Ziemssen has received personal compensation for participating on advisory boards, trial steering committees and data and safety monitoring committees, as well as for scientific talks and project support from: Bayer HealthCare, Biogen Idec, Elan, Genzyme, Merck Serono, Novartis, Roche, Sanofi-Aventis, Synthon and Teva.
Independent writing and editing assistance for the preparation of this abstract was provided by Oxford PharmaGenesis, Oxford, UK, funded by grants from AbbVie and Actelion Pharmaceuticals and an educational grant from Novartis, all of whom had no influence on the content.