VA Puget Sound Health Care System
Rehabilitation Care Service

Author Of 2 Presentations

Comorbidities Poster Presentation

P0448 - Comorbidities as predictors of all-cause emergency room usage in multiple sclerosis (ID 1345)

Speakers
Presentation Number
P0448
Presentation Topic
Comorbidities

Abstract

Background

Certain comorbidities have been identified as being associated with hospitalization rates among persons with multiple sclerosis (MS); however, to date, there is limited information on their relationship with all-cause emergency room (ER) usage, which can be financially burdensome.

Objectives

1) To determine if the presence of comorbidities increases the odds of ER usage and 2) examine if certain groups of comorbidities are associated with utilization.

Methods

Data were extracted from the VA MS Center of Excellence Data Repository, which includes electronic health record-based information from US Veterans receiving services at any Veterans Affairs (VA) medical center. CPT codes were used to determine if Veterans had at least one ER visit during a 24-month time frame. Comorbidities were identified using ICD-9 codes present prior to 2013, and were grouped by ICD-9 category, with the exception of traumatic brain injuries (TBI), pain disorders, and sleep disorders, which were separate categories. Separate logistic regressions were conducted for the overall number of comorbidities and categorized comorbidities, controlling for age and gender.

Results

Nearly 32% (n = 1,191) had at least one ER visit, with those Veterans having an average of 6.67 ± 3.32 comorbidities. After controlling for age and gender, the number of comorbidities was a significant predictor of ER usage (odds ratio [OR]: 1.21). The odds of ER usage were higher among Veterans with co-occurring TBIs (OR: 1.62), pain (OR: 1.60), circulatory (OR: 1.50), nervous system and sense organ (OR: 1.48), digestive (OR: 1.46), neoplasms (OR: 1.42), respiratory (OR: 1.32), mental (OR: 1.32), and sleep disorders (OR: 1.20).

Conclusions

All-cause ER utilization is prevalent among Veterans with MS, with usage increasing in the presence of other chronic comorbidities. These findings underscore the need to view long-term MS care through the lens of chronic disease management and suggest that addressing comorbidities may be important to reduce all-cause emergency care, through such critical strategies as preventive and health promotion programs (e.g., physical activity for pain and circulatory disorders), self-management (e.g., patient activation and engagement in care), and increased coordination among healthcare providers of key disorders to optimize and reinforce good care.

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Rehabilitation and Comprehensive Care Poster Presentation

P1103 - Moderators of improvements in fatigue impact following a self-management intervention in multiple sclerosis (ID 835)

Speakers
Presentation Number
P1103
Presentation Topic
Rehabilitation and Comprehensive Care

Abstract

Background

Fatigue is one of the most common and disabling symptoms of multiple sclerosis (MS). A recent randomized controlled trial (RCT) showed a self-management program for fatigue and a general MS education program that controlled for time and attention had equivalent effects on reducing fatigue impact in adults with MS.

Objectives

Examine moderators of treatment-related improvements in fatigue impact following self-management and education interventions in adults with MS.

Methods

Secondary analysis of a recent RCT (N=218) using multilevel modeling to assess moderators of treatment improvements in fatigue impact through six-month follow-up. Hypothesized moderators included age, gender, cohabitation with or without a spouse/partner, MS subtype (relapsing-remitting MS or progressive MS) as well as baseline depression symptoms, sleep disturbance, and self-efficacy.

Results

Living with or without a spouse/partner moderated intervention effects on fatigue impact through the six-month follow-up (b = -0.23, t(588) = 2.09, p = .04; controlling for MS subtype and income). The findings suggested that, in the fatigue self-management group, participants living with a spouse/partner showed greater improvement in fatigue impact (within group Cohen’s d = 0.55) compared to participants who did not live with a spouse/partner (d = 0.14). However, in the general MS education group, improvements in fatigue impact were similar between participants living with a spouse/partner (d = 0.23) and those who did not live with a spouse/partner (d = 0.50). Age, gender, MS subtype and baseline depression symptoms, sleep disturbance, and self-efficacy did not moderate treatment effects on fatigue impact.

Conclusions

Although the findings are exploratory, this study emphasizes that the presence of a close relationship may facilitate benefit from self-management interventions for MS-related fatigue. Future research should investigate how to promote engaging supportive others in self-management interventions for MS-related fatigue.

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