Impact of COVID-19 and system recovery in delivering healthcare to people with multiple sclerosis: a population-based Study.
COVID-19
DMTs
Epidemiology
Healthcare
Multiple sclerosis
Pandemic
Recovery
Journal
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
ISSN: 1590-3478
Titre abrégé: Neurol Sci
Pays: Italy
ID NLM: 100959175
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
15
06
2023
accepted:
31
08
2023
medline:
23
10
2023
pubmed:
6
9
2023
entrez:
6
9
2023
Statut:
ppublish
Résumé
COVID-19 pandemic has affected the management of multiple sclerosis (MS). To explore the impact of COVID-19 on healthcare delivery to people with MS and the subsequent recovery of the system. In this population-based study in the Campania Region (Italy), we included people with MS across pre-COVID-19, lockdown, pre-vaccination, and vaccination periods. Differences in continuous outcomes between periods were explored using linear mixed models (annualized hospitalization rate (AHR) and adherence measured as medication possession ratio (MPR)). Differences in disease-modifying treatment (DMT) prescription rates (first DMT prescription, any DMT switch, switch from platform to highly effective DMT, and combination of first DMT prescription and any DMT switch) were assessed using an interrupted time series design. Compared with pre-COVID-19, AHR decreased during the lockdown (Coeff = 0.64;95%CI = -0.69, -0.59; p < 0.01), and remained lower during pre-vaccination and vaccination periods. Adherence decreased during pre-vaccination (Coeff = -0.04;95%CI = -0.05, -0.03; p < 0.01) and vaccination periods (Coeff = -0.07;95%CI = -0.08, -0.07; p < 0.01). After the lockdown, there was an increase in any DMT switch (IRR 2.05 95%CI 1.38,3.05; p < 0.01), in switch from platform to highly effective DMTs (IRR 4.45;95%CI 2.48,8.26; p < 0.01) and in first DMT prescriptions (IRR 2.48;95%CI 1.64,3.74; p < 0.01). DMT prescriptions quickly returned to pre-pandemic levels, reflecting good health system recovery. However, adherence has remained lower than the past, as from suboptimal care. Assessing long-term COVID-19 impact on MS healthcare is warranted.
Sections du résumé
BACKGROUND
BACKGROUND
COVID-19 pandemic has affected the management of multiple sclerosis (MS).
OBJECTIVE
OBJECTIVE
To explore the impact of COVID-19 on healthcare delivery to people with MS and the subsequent recovery of the system.
METHODS
METHODS
In this population-based study in the Campania Region (Italy), we included people with MS across pre-COVID-19, lockdown, pre-vaccination, and vaccination periods. Differences in continuous outcomes between periods were explored using linear mixed models (annualized hospitalization rate (AHR) and adherence measured as medication possession ratio (MPR)). Differences in disease-modifying treatment (DMT) prescription rates (first DMT prescription, any DMT switch, switch from platform to highly effective DMT, and combination of first DMT prescription and any DMT switch) were assessed using an interrupted time series design.
RESULTS
RESULTS
Compared with pre-COVID-19, AHR decreased during the lockdown (Coeff = 0.64;95%CI = -0.69, -0.59; p < 0.01), and remained lower during pre-vaccination and vaccination periods. Adherence decreased during pre-vaccination (Coeff = -0.04;95%CI = -0.05, -0.03; p < 0.01) and vaccination periods (Coeff = -0.07;95%CI = -0.08, -0.07; p < 0.01). After the lockdown, there was an increase in any DMT switch (IRR 2.05 95%CI 1.38,3.05; p < 0.01), in switch from platform to highly effective DMTs (IRR 4.45;95%CI 2.48,8.26; p < 0.01) and in first DMT prescriptions (IRR 2.48;95%CI 1.64,3.74; p < 0.01).
CONCLUSIONS
CONCLUSIONS
DMT prescriptions quickly returned to pre-pandemic levels, reflecting good health system recovery. However, adherence has remained lower than the past, as from suboptimal care. Assessing long-term COVID-19 impact on MS healthcare is warranted.
Identifiants
pubmed: 37672178
doi: 10.1007/s10072-023-07052-9
pii: 10.1007/s10072-023-07052-9
pmc: PMC10570189
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3771-3779Subventions
Organisme : Regione Campania
ID : E65E22000370002
Informations de copyright
© 2023. The Author(s).
Références
Int J Environ Res Public Health. 2020 May 13;17(10):
pubmed: 32414017
Int J Epidemiol. 2017 Feb 1;46(1):348-355
pubmed: 27283160
Rev Neurol. 2019 Mar 16;68(6):229-235
pubmed: 30855706
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
J Neurol. 2022 Dec;269(12):6504-6511
pubmed: 35953597
Eur J Neurol. 2013 Aug;20(8):1153-60
pubmed: 23496086
JACC Case Rep. 2020 Jul 15;2(9):1414-1418
pubmed: 32835287
PLoS One. 2021 Mar 10;16(3):e0246454
pubmed: 33690641
Biomed Res Int. 2015;2015:217047
pubmed: 26539470
Mult Scler Relat Disord. 2021 May;50:102856
pubmed: 33662858
Neurology. 2020 Jun 2;94(22):949-952
pubmed: 32241953
Neurology. 2015 Jan 27;84(4):350-8
pubmed: 25540309
JAMA Neurol. 2021 Jun 1;78(6):699-708
pubmed: 33739362
JAMA Neurol. 2022 Mar 1;79(3):307-309
pubmed: 35072702
Nurs Crit Care. 2021 Mar;26(2):94-101
pubmed: 33448567
Mult Scler. 2020 Sep;26(10):1163-1171
pubmed: 32772807
JAMA Netw Open. 2021 Dec 1;4(12):e2136697
pubmed: 34851401
Mult Scler Relat Disord. 2020 Nov;46:102512
pubmed: 32977074
Ann Ig. 2022 Jan-Feb;34(1):27-44
pubmed: 33779676
Biomed Pharmacother. 2023 Feb;158:114129
pubmed: 36527843
Mult Scler. 2022 Apr;28(4):597-607
pubmed: 35332815
Nat Med. 2023 Feb;29(2):334-343
pubmed: 36797482
Eur J Neurol. 2021 Oct;28(10):3403-3410
pubmed: 33896086
Mult Scler Relat Disord. 2023 Mar;71:104585
pubmed: 36827873