title: Treatment patterns of multiple sclerosis patients: a comparison of veterans and non-veterans using the NARCOMS registry.
abstract: Multiple sclerosis (MS) is a chronic illness of the central nervous system, with a highly variable clinical course. Available therapies are only partially effective and as a consequence treatment patterns between patients can be varied. Longitudinal databases consisting of large cohorts where successive and sequential data is collected may reveal disease and treatment characteristics not apparent when data is gathered during clinical trials that consist usually of relatively homogeneous patients followed for short durations. We analysed data from the North American Research Committee on Multiple Sclerosis registry, a self-reported database, to assess MS patient characteristics and treatment patterns, with a focus on veterans. We show that the Veteran Healthcare Administration (VHA) system of medical centres care for a greater number of patients with higher average disability but not necessarily patients who report primary progressive or actively worsening disease. We also show that the VHA medical centres appear to better provide multidisciplinary care, particularly in the areas of social work, physical therapy and urology. In general, treatment patterns for symptomatic therapies follow similar patterns across veterans and non-veterans groups. Treatment patterns for immunomodulatory agents suggest that VHA veterans use IMA less frequently than either non-VHA veterans or non-veterans.
authors.affiliation: Department of Neurology, Yale School of Medicine and VA Connecticut Healthcare System, West Haven, CT 06516, USA. albert.lo@yale.edu
authors.forename: Albert C
authors.initials: AC
authors.lastname: Lo
authors.forename: Olympia
authors.initials: O
authors.lastname: Hadjimichael
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Vollmer
mesh_terms: D000276:Adjuvants, Immunologic / Q000627:therapeutic use; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000529:Complementary Therapies; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology; D004185:Disability Evaluation; D005221:Fatigue / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000188:drug therapy* / Q000453:epidemiology*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy* / Q000453:epidemiology*; D009128:Muscle Spasticity / Q000188:drug therapy / Q000453:epidemiology; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology; D010348:Patient Care Team; D015995:Prevalence; D012042:Registries; D012044:Regression Analysis; D017678:Sex Distribution; D014481:United States; D014493:United States Department of Veterans Affairs; D001745:Urinary Bladder Diseases / Q000188:drug therapy / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D000276:Adjuvants, Immunologic; D000700:Analgesics