Semester

Fall

Date of Graduation

2006

Document Type

Dissertation

Degree Type

PhD

College

School of Pharmacy

Department

Pharmaceutical Systems and Policy

Committee Chair

Lesley-Ann Miller.

Abstract

There are a large number of patient-reported questionnaires to assess health-related quality of life (HRQoL) in patients with multiple sclerosis (MS). In order to make a recommendation for use in clinical practice, a comparison of their psychometric properties is necessary. In addition to accurate assessment, it is also necessary to identify factors that have a significant impact on HRQoL. Further, lack of use of HRQoL information in clinical practice warrants examination of attitudes and behavior of neurologists about HRQoL assessment and their intention to consider incorporating HRQoL information in their decision making. This study collected data from patients with MS as well as neurologists and consisted of two phases. Phase I involved collection of primary data from non-institutionalized patients with MS. Data from Phase I was used to measure HRQoL, identify factors affecting HRQoL, and compare the measures on their psychometric properties. A mail survey of neurologists was performed in Phase II. This data facilitated investigation of factors that have a significant influence on neurologists' intention to assess HRQoL information in clinical practice. Possible predictors of intention such as: attitude, subjective norms, perceived behavior control and practice characteristics were included. Based on analyses of Phase I, no measure emerged clearly or consistently better or worse than the others in terms of psychometric properties. Hence, a recommendation of one particular measure for use in MS-related clinical practice cannot be substantiated. The choice of a measure ultimately rests on the neurologist and may be related to their perception of its usefulness and their intention to use such information in the routine care. With respect to predictors of HRQoL, visual function among other factors was found to have a significant and independent impact on HRQoL in patients with MS. This suggests that visual screening should be performed periodically using patient-reported questionnaires in addition to conventional tests of visual acuity. Over 90% of neurologists reported that they did not use standardized HRQoL questionnaires in clinical practice. Organizations such as the American Academy of Neurology and fellow neurologists can exert significant influence on neurologists' intention to assess HRQoL information in clinical practice.

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