Sudha Raghunath1,2, Raif Hijjawi3, Elizabeth Hoon4, E Michael Shanahan5,6, Fiona Goldblatt5,6. 1. Rheumatology Unit, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia. sudha.raghunath@monash.edu. 2. Centre for Inflammatory Diseases, Monash University, Melbourne, Australia. sudha.raghunath@monash.edu. 3. Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia. 4. University of Adelaide, Adelaide, Australia. 5. Rheumatology Unit, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia. 6. Flinders University, Adelaide, Australia.
Abstract
INTRODUCTION/ OBJECTIVES: Despite close management in specialized clinics, medication adherence remains a significant problem for some patients. The study aims to explore factors affecting medication adherence in patients attending a biologics clinic. METHOD: Participants completed surveys including the Compliance Questionnaire Rheumatology (CQR) to quantify adherence rates. Purposive sampling targeting poorly adherent patients was used to select individuals for qualitative evaluation. Semi-structured interviews were performed and continued until saturation was achieved. Interviews were transcribed and coded using NVivo. Principles of grounded theory were used for data analysis. RESULTS: A total of 123 patients completed the survey (72 RA, 33 PsA, 18 AS). Of which, 96 patients completed all CQR items, of these 72% were identified as adequately adherent. A major theme which emerged from patient interviews was that the presence of active symptoms significantly influenced adherence. Patients tended not to prioritize medication taking until they had a recurrence of symptoms. Despite describing biologics as "life-changing", patients expressed concern regarding potential long-term side effects of these medications which affected adherence. Patients identified their relationship with their rheumatologist as pivotal and perceived diet, exercise and stress as critical. Intentional factors were the predominant drivers for non-adherence; patients made a risk-benefit analysis based on their beliefs and chose to not take their medications as prescribed. CONCLUSIONS: Medication adherence to traditional and biological therapies was lower than expected by treating clinicians in this patient group, who are closely supported in a dedicated biologics clinic. Several of the identified themes suggest that shared decision making and enhancing patient education may improve adherence in this group. Key Points • Adherence rates are suboptimal even in supported, educated, English-speaking patients in the biologics era. • Contributing factors were 'intentional' as patients chose to be non-adherent based on their beliefs. • Emergent themes suggest that enhancing patient education could improve adherence.
INTRODUCTION/ OBJECTIVES: Despite close management in specialized clinics, medication adherence remains a significant problem for some patients. The study aims to explore factors affecting medication adherence in patients attending a biologics clinic. METHOD:Participants completed surveys including the Compliance Questionnaire Rheumatology (CQR) to quantify adherence rates. Purposive sampling targeting poorly adherent patients was used to select individuals for qualitative evaluation. Semi-structured interviews were performed and continued until saturation was achieved. Interviews were transcribed and coded using NVivo. Principles of grounded theory were used for data analysis. RESULTS: A total of 123 patients completed the survey (72 RA, 33 PsA, 18 AS). Of which, 96 patients completed all CQR items, of these 72% were identified as adequately adherent. A major theme which emerged from patient interviews was that the presence of active symptoms significantly influenced adherence. Patients tended not to prioritize medication taking until they had a recurrence of symptoms. Despite describing biologics as "life-changing", patients expressed concern regarding potential long-term side effects of these medications which affected adherence. Patients identified their relationship with their rheumatologist as pivotal and perceived diet, exercise and stress as critical. Intentional factors were the predominant drivers for non-adherence; patients made a risk-benefit analysis based on their beliefs and chose to not take their medications as prescribed. CONCLUSIONS: Medication adherence to traditional and biological therapies was lower than expected by treating clinicians in this patient group, who are closely supported in a dedicated biologics clinic. Several of the identified themes suggest that shared decision making and enhancing patient education may improve adherence in this group. Key Points • Adherence rates are suboptimal even in supported, educated, English-speaking patients in the biologics era. • Contributing factors were 'intentional' as patients chose to be non-adherent based on their beliefs. • Emergent themes suggest that enhancing patient education could improve adherence.
Authors: Kazuki Yoshida; Yoon-Kyoung Sung; Arthur Kavanaugh; Sang-Cheol Bae; Michael E Weinblatt; Mitsumasa Kishimoto; Kazuo Matsui; Shigeto Tohma; Daniel H Solomon Journal: Ann Rheum Dis Date: 2013-05-30 Impact factor: 19.103
Authors: Annelieke Pasma; Ethan den Boer; Adriaan van 't Spijker; Reininer Timman; Bart van den Bemt; Jan J V Busschbach; Johanna M W Hazes Journal: Rheumatology (Oxford) Date: 2016-06-27 Impact factor: 7.580
Authors: Catharine Morgan; John McBeth; Lis Cordingley; Kath Watson; Kimme L Hyrich; Deborah P M Symmons; Ian N Bruce Journal: Rheumatology (Oxford) Date: 2015-05-13 Impact factor: 7.580
Authors: Annelieke Pasma; Charlotte V Schenk; Reinier Timman; Jan J V Busschbach; Bart J F van den Bemt; Esmeralda Molenaar; Willemijn H van der Laan; Saskia Schrauwen; Adriaan Van't Spijker; Johanna M W Hazes Journal: Arthritis Res Ther Date: 2015-10-08 Impact factor: 5.156