Ayano Kelly1, Luke Crimston-Smith1, Allison Tong1, Susan J Bartlett1, Charlotte Bekker1, Robin Christensen1, Mary A De Vera1, Maarten de Wit1, Vicki Evans1, Michael Gill1, Lyn March1, Karine Manera1, Robby Nieuwlaat1, Shahrzad Salmasi1, Marieke Scholte-Voshaar1, Jasvinder A Singh1, Daniel Sumpton1, Karine Toupin-April1, Peter Tugwell1, Bart van den Bemt1, Suzanne Verstappen1, Kathleen Tymms1. 1. From the College of Health and Medicine, Australian National University, Canberra, ACT, Australia; Canberra Rheumatology, Canberra, ACT, Australia;; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia; Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Department of Medicine, McGill University and Research Institute, McGill University Health Centres, Montreal, Canada; Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA; Department of pharmacy, Radboud University Medical Centre, Nijmegen, Netherlands; Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark; Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Richmond, British Columbia, Canada; OMERACT Patient Research Partner, Netherlands; Clear Vision Consulting, Canberra, ACT, Australia; Discipline of Optometry, University of Canberra, Canberra, ACT, Australia; Dragon Claw, Sydney, NSW, Australia; Institute of Bone and Joint Research, Kolling Institute of Medical Research, Sydney, NSW, Australia; Department of Rheumatology, Royal North Shore Hospital, Sydney, NSW, Australia; Northern Clinical School, The University of Sydney, Sydney, NSW, Australia; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands; Medicine Service, VA Medical Center, Birmingham, Alabama, USA; Department of Medicine, School of Medicine, University of Alabama, Birmingham, Alabama, USA; Division of Epidemiology, School of Public Health, University of Alabama, Birmingham, Alabama, USA; Department of Rheumatology, Concord Hospital, Sydney, NSW, Australia; The Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Pharmacy, Sint Maartenskliniek, Ubbergen, Netherlands;. Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK; Department of Rheumatology, Canberra Hospital, Canberra, ACT, Australia. The work reported in this manuscript was supported by the 2018 Arthritis Australia Project Grant. AK is supported by the Australian Government Research Training Scholarship. SV is supported by Versus Arthritis (grant numbers 20385) and NIHR Manchester Biomedical Research Centre. RC (The Parker Institute, Bispebjerg and Frederiksberg Hospital) is supported by a core grant from the Oak Foundation (OCAY-13-309). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Address correspondence to Ayano Kelly, 40 Marcus Clarke St, Canberra City, ACT 2601, Australia, ayano.kelly@anu.edu.au.
Abstract
OBJECTIVE: Non-adherence to medications is common in rheumatic conditions and associated with increased morbidity. Heterogeneous outcome reporting by researchers compromises the synthesis of evidence of interventions targeting adherence. We aimed to assess the scope of outcomes in interventional studies of medication adherence. METHODS: We searched electronic databases to February 2019 for published randomized controlled trials and observational studies of interventions with the primary outcome of medication adherence including adults with any rheumatic condition, written in English. We extracted and analyzed all outcome domains and adherence measures with pre-specified extraction and analysis protocols. RESULTS: Overall, 53 studies reported 71 outcome domains classified into adherence (1 domain), health outcomes (38 domains) and adherence-related factors (e.g. medication knowledge) (32 domains). We subdivided adherence into three phases: initiation (n=13 studies, 25%); implementation (n=32, 60%); persistence (n=27, 51%); phase unclear (n=20, 38%). Thirty-seven different instruments reported adherence in 115 unique ways (this includes different adherence definitions and calculations, metric and method of aggregation). Forty-one studies (77%) reported health outcomes. The most frequently reported were: medication adverse events (n=24, 45%); disease activity (n=11, 21%); bone turnover markers/physical function/quality of life (each n=10, 19%). Thirty-three studies (62%) reported adherence-related factors. The most frequently reported were: medication beliefs (n=8, 15%); illness perception/medication satisfaction/satisfaction with medication information (each n=5, 9%); condition knowledge/medication knowledge/trust in doctor (each n=3, 6%). CONCLUSION: The outcome domains and adherence measures in interventional studies targeting adherence are heterogeneous. Consensus on relevant outcomes will improve the comparison of different strategies to support medication adherence in rheumatology.
OBJECTIVE: Non-adherence to medications is common in rheumatic conditions and associated with increased morbidity. Heterogeneous outcome reporting by researchers compromises the synthesis of evidence of interventions targeting adherence. We aimed to assess the scope of outcomes in interventional studies of medication adherence. METHODS: We searched electronic databases to February 2019 for published randomized controlled trials and observational studies of interventions with the primary outcome of medication adherence including adults with any rheumatic condition, written in English. We extracted and analyzed all outcome domains and adherence measures with pre-specified extraction and analysis protocols. RESULTS: Overall, 53 studies reported 71 outcome domains classified into adherence (1 domain), health outcomes (38 domains) and adherence-related factors (e.g. medication knowledge) (32 domains). We subdivided adherence into three phases: initiation (n=13 studies, 25%); implementation (n=32, 60%); persistence (n=27, 51%); phase unclear (n=20, 38%). Thirty-seven different instruments reported adherence in 115 unique ways (this includes different adherence definitions and calculations, metric and method of aggregation). Forty-one studies (77%) reported health outcomes. The most frequently reported were: medication adverse events (n=24, 45%); disease activity (n=11, 21%); bone turnover markers/physical function/quality of life (each n=10, 19%). Thirty-three studies (62%) reported adherence-related factors. The most frequently reported were: medication beliefs (n=8, 15%); illness perception/medication satisfaction/satisfaction with medication information (each n=5, 9%); condition knowledge/medication knowledge/trust in doctor (each n=3, 6%). CONCLUSION: The outcome domains and adherence measures in interventional studies targeting adherence are heterogeneous. Consensus on relevant outcomes will improve the comparison of different strategies to support medication adherence in rheumatology.
Authors: Shahrzad Salmasi; Ayano Kelly; Susan J Bartlett; Maarten de Wit; Lyn March; Allison Tong; Peter Tugwell; Kathleen Tymms; Suzanne Verstappen; Mary A De Vera Journal: BMC Rheumatol Date: 2021-07-08