1. Unsatisfactory outcomes in myasthenia gravis: influence by care providers
- Author
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Thierry Kuntzer, Murielle Dunand, François-Xavier Borruat, François Spertini, Stephan A. Botez, and Pascale Roux-Lombard
- Subjects
Glucocorticoids/therapeutic use ,Male ,Health Personnel/standards/*statistics & numerical data ,Exacerbation ,Cholinesterase Inhibitors/therapeutic use ,Adverse drug effects ,Prednisone/therapeutic use ,Pyridostigmine Bromide/therapeutic use ,Treatment compliance ,Clinical Protocols ,Neurology/standards/statistics & numerical data ,Azathioprine ,Outcome Assessment, Health Care ,Medicine ,Immunoglobulins, Intravenous/therapeutic use ,Prospective Studies ,Treatment Failure ,Young adult ,Prospective cohort study ,Child ,ddc:616 ,Aged, 80 and over ,Thymectomy/statistics & numerical data ,Immunoglobulins, Intravenous ,Middle Aged ,Thymectomy ,Neurology ,Female ,Outcome Assessment (Health Care)/*methods ,Immunosuppressive Agents ,Pyridostigmine Bromide ,Adult ,medicine.medical_specialty ,Adolescent ,Health Personnel ,Young Adult ,Internal medicine ,Myasthenia Gravis ,Humans ,In patient ,Mortality ,Glucocorticoids ,Aged ,Quality of Health Care ,business.industry ,medicine.disease ,Quality of Health Care/standards/*statistics & numerical data ,Myasthenia gravis ,Surgery ,Institutional repository ,Azathioprine/therapeutic use ,Health Personnel/standards ,Health Personnel/statistics & numerical data ,Immunosuppressive Agents/therapeutic use ,Myasthenia Gravis/drug therapy ,Myasthenia Gravis/mortality ,Neurology/standards ,Neurology/statistics & numerical data ,Outcome Assessment (Health Care)/methods ,Quality of Health Care/standards ,Quality of Health Care/statistics & numerical data ,Myasthenia Gravis/*drug therapy/*mortality/surgery ,Prednisone ,Neurology (clinical) ,Cholinesterase Inhibitors ,business - Abstract
Myasthenia gravis (MG) can be difficult to treat despite an available therapeutic armamentarium. Our aim was to analyze the factors leading to unsatisfactory outcome (UO). To this end we used the Myasthenia Gravis Foundation of America classification system. Forty one patients with autoimmune MG were followed prospectively from January 2003 to December 2007. Outcomes were assessed throughout follow-up and at a final visit. 'Unchanged', 'worse', 'exacerbation' and 'died of MG' post-intervention status were considered UOs. During follow-up, UO rates reached 54% and were related to undertreatment (41%), poor treatment compliance (23%), infections (23%), and adverse drug effects (13%). The UO rate at final study assessment was 20%. UO during follow-up was significantly (P = 0.004) predictive of UOs at final assessment. When care was provided by neuromuscular (NM) specialists, patients had significantly better follow-up scores (P = 0.01). At final assessment UO rates were 7% and significantly better in patients treated by NM specialists, compared to other physicians where UO rates reached 27%. UO was a frequent finding occurring in more than half our patients during follow-up. Nearly two-thirds of the UOs could have been prevented by appropriate therapeutic adjustments and improved compliance. The differential UO rates at follow-up, their dependency on the degree to which the management was specialized and their correlation with final outcomes suggest that specialized MG care improves outcomes.
- Published
- 2009