Hanneke E Zwikker1, Cornelia H van den Ende2, Wim G van Lankveld3, Alfons A den Broeder2, Frank H van den Hoogen2, Birgit van de Mosselaar2, Sandra van Dulmen4, Bart J van den Bemt5. 1. Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands. Electronic address: h.zwikker@maartenskliniek.nl. 2. Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands. 3. HAN University of Applied Sciences, Institute of Health Studies, The Netherlands. 4. NIVEL (Netherlands Institute for Health Services Research), The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, The Netherlands; Department of Health Science, Buskerud University College, Drammen, Norway. 5. Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, P.O. Box 9011, 6500 GM Nijmegen, The Netherlands; Department of Pharmacy, Radboud University Medical Centre, The Netherlands. Electronic address: b.vandenbemt@maartenskliniek.nl.
Abstract
OBJECTIVE: To assess the effect of a group-based intervention on the balance between necessity beliefs and concern beliefs about medication and on medication non-adherence in patients with rheumatoid arthritis (RA). METHODS:Non-adherent RA patients using disease-modifying anti-rheumatic drugs (DMARDs) were randomized to an intervention or control arm. The intervention consisted, amongst others, of two motivational interviewing-guided group sessions led by the same pharmacist. Control patients received brochures about their DMARDs. Questionnaires were completed up to 12 months follow-up. RESULTS:123 patients (mean age: 60 years, female: 69%) were randomized. No differences in necessity beliefs and concern beliefs about medication and in medication non-adherence were detected between the intervention and control arm, except at 12 months' follow-up: participants in the intervention arm had less strong necessity beliefs about medication than participants in the control arm (b: -1.0 (95% CI: -2.0, -0.1)). CONCLUSION: This trial did not demonstrate superiority of our intervention over the control arm in changing beliefs about medication or in improving medication adherence over time. PRACTICE IMPLICATIONS: Absent intervention effects might have been due to, amongst others, selection bias and a suboptimal treatment integrity level. Hence, targeting beliefs about medication in clinical practice should not yet be ruled out.
RCT Entities:
OBJECTIVE: To assess the effect of a group-based intervention on the balance between necessity beliefs and concern beliefs about medication and on medication non-adherence in patients with rheumatoid arthritis (RA). METHODS: Non-adherent RApatients using disease-modifying anti-rheumatic drugs (DMARDs) were randomized to an intervention or control arm. The intervention consisted, amongst others, of two motivational interviewing-guided group sessions led by the same pharmacist. Control patients received brochures about their DMARDs. Questionnaires were completed up to 12 months follow-up. RESULTS: 123 patients (mean age: 60 years, female: 69%) were randomized. No differences in necessity beliefs and concern beliefs about medication and in medication non-adherence were detected between the intervention and control arm, except at 12 months' follow-up: participants in the intervention arm had less strong necessity beliefs about medication than participants in the control arm (b: -1.0 (95% CI: -2.0, -0.1)). CONCLUSION: This trial did not demonstrate superiority of our intervention over the control arm in changing beliefs about medication or in improving medication adherence over time. PRACTICE IMPLICATIONS: Absent intervention effects might have been due to, amongst others, selection bias and a suboptimal treatment integrity level. Hence, targeting beliefs about medication in clinical practice should not yet be ruled out.
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