Estimate the extent to which adults with MS are screened and treated for CDF using chart-abstracted data and provider interviews from a large, urban MS comprehensive care center.

CDF in adults with MS are frequently underdiagnosed and undertreated, potentially due to symptom overlap, patient under-reporting, limited sensitivity of screening tools, and time constraints.

A mixed-methods approach was used to retrospectively analyze electronic health records data for documentation of CDF screenings and treatment among adults (≥18 years) with MS (N=260) with 2+ visits with an MS specialist (N=8) in any 12-month period between 1/2018?12/2019. Qualitative data were collected from semi-structured interviews (N=6) with providers (conducted 6/2020) and from chart review of subjective notations of CDF symptoms. Bivariate analysis evaluated the relationship between screening, recognition, and treatment rates and patient and provider covariates for groups with sufficient sample size (N=30). P<0.05 indicated statistical significance.

Most patients in the sample were female (75%), white (50%), and 45?64 years old (49%). While subjective notations of CDF were noted by providers in the majority of charts reviewed, rates of screening tool use were significantly lower. Screening for depression occurred at the highest rate (24%), followed by cognitive impairment (2%) and fatigue (0%). Higher depression screening rates were associated with white race, patients with ≤2 visits during the study period, provider experience >10 years, and providers who mentioned the practice-level initiative to administer annual depression screenings (all P<0.05). Despite low documentation of screening tool use, pharmacologic and nonpharmacologic treatment recommendations for CDF were documented in patient charts. Physicians were more likely to prescribe pharmacologic treatments compared with nurse practitioners (P<0.01).

Providers recognize CDF as important for patients and document subjective notations of symptoms in patient notes, but screening tools are underused. Depression-focused institutional priorities at the center may have contributed to higher depression screening rates.