Michael Hatzakis

Prevalence and correlates of depression among veterans with multiple sclerosis

Objectives: To establish the prevalence of major depressive episode (MDE) in a large sample of veterans with multiple sclerosis (MS); to identify demographic characteristics, aspects of disease presentation, and perceptions of disability associated with greater concurrent risk for MDE; and to examine the relationship between MDE, service utilization, and activity participation. Methods: Veterans with MS (n = 1,032) were identified via computer database and surveyed by mail; 451 (43.7%) responded. Results: Twenty-two percent of the sample met criteria for current MDE. Low income, unemployment, presence of falls, younger age, absence of a marital partner, and high levels of perceived disability due to bowel functioning were independently associated with MDE. Disease subtype, disease duration, use of disease modifying therapies, and perceived disability due to mobility or bladder problems were unrelated to MDE. Current MDE was in turn associated with increased primary care visits and increased impact of disease upon activity participation. Similar correlates were associated with minor depressive episode. Conclusions: Unlike the general population, rates of depression in this predominantly male sample were similar to those found in predominantly female samples of persons with multiple sclerosis. Specific aspects of disability were differentially associated with depression, and depression was independently associated with increased service utilization and increased participation limitations.

Complementary and alternative medicine use in veterans with multiple sclerosis: Prevalence and demographic associations

The present study explored complementary and alternative medicine (CAM) use in veterans with multiple sclerosis (MS). We administered self-report questionnaires to 451 veterans who received healthcare from Veterans Health Administration facilities. CAM use among veterans with MS was widespread; 37% of respondents reported current or past use. Roughly 33% of CAM users reported using multiple interventions, and 40% of respondents desired interventions that they were not already using. Logistic regression suggested that CAM use was more likely among participants with graduate-level education, poor self-reported health over the past year, and a progressive relapsing MS subtype. Participants who used traditional medical services were also more likely to use CAM, which suggests that CAM services are used in addition to, as opposed to in place of, traditional services. As others have proposed, these results suggest that care providers who work with persons with MS would be well served to understand, routinely screen for, and make use of CAM when appropriate.

Use of medical informatics for management of multiple sclerosis using a chronic-care model.

The mission of the Multiple Sclerosis Centers of Excellence (MSCoEs) is to optimize the services veterans with multiple sclerosis (MS) receive across the U.S. Veterans Health Administration. To accomplish this mission, the MSCoE West has adopted a collaborative chronic-disease management strategy along the lines of the model described by Wagner and colleagues. This model describes an organized, integrated, proactive, and population-based approach to patient care that includes healthcare delivery system change and patient-based self-management. While Wagners model is described independent of information technology, the majority of actions called for in that model benefit tremendously from the application of a powerful and well-integrated informatics infrastructure designed to serve and support populations with chronic disease. Key elements such as goals and actions encourage high-quality care for those with chronic illnesses.

Exploring educational needs of multiple sclerosis care providers: Results of a care-provider survey

Our objective was to survey experienced multiple sclerosis (MS) care providers, determine their ongoing professional educational needs, and develop future education programs. We asked providers across a variety of disciplines to identify the areas in which clinical consultation and continuing medical education (CME) would most improve their ability to provide care to individuals with MS; their preferred education modalities; and their confidence in providing care related to disease-modifying agents (DMAs), fatigue, depression, spasticity, and bladder management. At a national meeting of MS professionals, 152 MS care providers completed a self-report survey that was designed for this cross-sectional cohort study. Areas of greatest interest for clinical consultation and CME were identical and included cognition, fatigue, DMA use, spasticity, pain, sex, diagnosis of MS, and depression. Participants expressed a preference for live and interactive CME modalities. Confidence in providing specific disease-related care sometimes differed between Veterans Health Administration (VHA) and non-VHA providers. The results indicate that clinical consultations and CME should be targeted to the topics of greatest interest identified by providers and delivered in a live or interactive modality whenever possible.

The rest of the iceberg: supporting an internal community of Web site content creators and reviewers

Many websites attempt to provide reliable (e.g. peer-reviewed) and timely information in difficult and dynamic content areas. In such cases, the visible public site is only the tip of the proverbial iceberg. In addition to the design and delivery of content on the public site, there needs to be a reliable and effective system (which may include other linked websites) by which content creators and reviewers work together in the development and review of site content. In addition, this system may have to provide an efficient method for approved content to be formatted appropriately and posted on the public site. There can be many challenges to establishing and maintaining such a system in support of an internal website community of content creators and review board members. These challenges can be caused or exacerbated by: geographical separation, multiple disciplinary perspectives, differing levels of technical expertise, and the need to coordinate across organizational boundaries. The website of the Multiple Sclerosis Centers of Excellence (MSCoE) is such a site, facing challenges like these in support of an internal community of website content creators and reviewers. This work describes the system we have implemented to address these challenges and support the work of this internal community, as well as to link the results of that work seamlessly to public website delivery. This system combines technical tools for managing and facilitating content and publication tasks with both informal and formal methods of interpersonal and team communication. The lessons learned in developing and supporting this internal operations community can be applied to other website projects with similar goals and issues.