Multilevel factors predict medication adherence in rheumatoid arthritis: a 6-month cohort study

Non-adherence challenges efficacy and costs of healthcare. Knowledge of the underlying factors is essential to design effective intervention strategies.ObjectivesTo estimate the prevalence of treatment adherence in rheumatoid arthritis (RA) and to evaluate its predictors.MethodsA 6-month prospective...

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Veröffentlicht in:	Annals of the rheumatic diseases Jg. 81; H. 3; S. 327 - 334
Hauptverfasser:	Balsa, Alejandro, García de Yébenes, Maria Jesus, Carmona, Loreto, Courel, Laura Garrido, Mendizábal, Javier, Restrepo, Juliana, Fábregas, Dolores, Saenz de Buruaga, Joana Atxotegi, Etxebarrieta, Javier Duruelo, Zavaleta, Nathali Rivas, Carmona, Eugenio Chamizo, Chaves, Lara, Rojas, Sara, Sivera, Francisca, Hernández, Laura Casas, Álvarez, Beatriz González, Centeno, Antonio Gómez, Graell, Eduard, Alperi, Mercedes, Holgado, Susana, Morillo, Melania Martinez, Varo, Fermín Medina, Linaza, Alba Pérez, García, Isabel Serrano
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	England BMJ Publishing Group Ltd and European League Against Rheumatism 01.03.2022 Elsevier Limited
Schlagworte:	Antirheumatic Agents - therapeutic use Arthritis, Rheumatoid - drug therapy Arthritis, Rheumatoid - psychology Assessment of Medication Adherence Biological Products - therapeutic use Chronic illnesses Cohort analysis Comorbidity Decision making Disease Drug stores Female health care health services research Hospitals Humans Logistic Models Male Medication adherence Medication Adherence - psychology Middle Aged Multilevel Analysis outcome and process assessment patient care team Patient compliance Patients Pharmacy Physician-Patient Relations Professionals Prospective Studies Questionnaires Rheumatoid arthritis Rheumatology Sociodemographics patient care team health services research outcome and process assessment health care
ISSN:	0003-4967, 1468-2060, 1468-2060
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Abstract	Non-adherence challenges efficacy and costs of healthcare. Knowledge of the underlying factors is essential to design effective intervention strategies.ObjectivesTo estimate the prevalence of treatment adherence in rheumatoid arthritis (RA) and to evaluate its predictors.MethodsA 6-month prospective cohort study of patients with RA selected by systematic stratified sampling (33% on first disease-modifying rheumatic drug (DMARD), 33% on second-line DMARD and 33% on biologics). The outcome measure was treatment adherence, defined by a score greater than 80% both in the Compliance Questionnaire in Rheumatology and the Reported Adherence to Medication scale, and was estimated with 95% CIs. Predictive factors included sociodemographic, psychological, clinical, drug-related, patient–doctor relationship related and logistic. Their effect on 6-month adherence was examined by multilevel logistic models adjusted for baseline covariates.Results180 patients were recruited (77% women, mean age 60.8). The prevalence of adherence was 59.1% (95% CI 48.1% to 71.8%). Patients on biologics showed higher adherence and perceived a higher medication need than the others; patients on second-line DMARDs had experienced more adverse events than the others. The variables explaining adherence in the final multivariate model were the type of treatment prescribed (second-line DMARDs OR=5.22, and biologics OR=3.76), agreement on treatment (OR=4.57), having received information on treatment adaptation (OR=1.42) and the physician perception of patient trust (OR=1.58). These effects were independent of disease activity.ConclusionTreatment adherence in RA is far from complete. Psychological, communicational and logistic factors influence treatment adherence in RA to a greater extent than sociodemographic or clinical factors.
AbstractList	Non-adherence challenges efficacy and costs of healthcare. Knowledge of the underlying factors is essential to design effective intervention strategies.ObjectivesTo estimate the prevalence of treatment adherence in rheumatoid arthritis (RA) and to evaluate its predictors.MethodsA 6-month prospective cohort study of patients with RA selected by systematic stratified sampling (33% on first disease-modifying rheumatic drug (DMARD), 33% on second-line DMARD and 33% on biologics). The outcome measure was treatment adherence, defined by a score greater than 80% both in the Compliance Questionnaire in Rheumatology and the Reported Adherence to Medication scale, and was estimated with 95% CIs. Predictive factors included sociodemographic, psychological, clinical, drug-related, patient–doctor relationship related and logistic. Their effect on 6-month adherence was examined by multilevel logistic models adjusted for baseline covariates.Results180 patients were recruited (77% women, mean age 60.8). The prevalence of adherence was 59.1% (95% CI 48.1% to 71.8%). Patients on biologics showed higher adherence and perceived a higher medication need than the others; patients on second-line DMARDs had experienced more adverse events than the others. The variables explaining adherence in the final multivariate model were the type of treatment prescribed (second-line DMARDs OR=5.22, and biologics OR=3.76), agreement on treatment (OR=4.57), having received information on treatment adaptation (OR=1.42) and the physician perception of patient trust (OR=1.58). These effects were independent of disease activity.ConclusionTreatment adherence in RA is far from complete. Psychological, communicational and logistic factors influence treatment adherence in RA to a greater extent than sociodemographic or clinical factors. Non-adherence challenges efficacy and costs of healthcare. Knowledge of the underlying factors is essential to design effective intervention strategies.Non-adherence challenges efficacy and costs of healthcare. Knowledge of the underlying factors is essential to design effective intervention strategies.To estimate the prevalence of treatment adherence in rheumatoid arthritis (RA) and to evaluate its predictors.OBJECTIVESTo estimate the prevalence of treatment adherence in rheumatoid arthritis (RA) and to evaluate its predictors.A 6-month prospective cohort study of patients with RA selected by systematic stratified sampling (33% on first disease-modifying rheumatic drug (DMARD), 33% on second-line DMARD and 33% on biologics). The outcome measure was treatment adherence, defined by a score greater than 80% both in the Compliance Questionnaire in Rheumatology and the Reported Adherence to Medication scale, and was estimated with 95% CIs. Predictive factors included sociodemographic, psychological, clinical, drug-related, patient-doctor relationship related and logistic. Their effect on 6-month adherence was examined by multilevel logistic models adjusted for baseline covariates.METHODSA 6-month prospective cohort study of patients with RA selected by systematic stratified sampling (33% on first disease-modifying rheumatic drug (DMARD), 33% on second-line DMARD and 33% on biologics). The outcome measure was treatment adherence, defined by a score greater than 80% both in the Compliance Questionnaire in Rheumatology and the Reported Adherence to Medication scale, and was estimated with 95% CIs. Predictive factors included sociodemographic, psychological, clinical, drug-related, patient-doctor relationship related and logistic. Their effect on 6-month adherence was examined by multilevel logistic models adjusted for baseline covariates.180 patients were recruited (77% women, mean age 60.8). The prevalence of adherence was 59.1% (95% CI 48.1% to 71.8%). Patients on biologics showed higher adherence and perceived a higher medication need than the others; patients on second-line DMARDs had experienced more adverse events than the others. The variables explaining adherence in the final multivariate model were the type of treatment prescribed (second-line DMARDs OR=5.22, and biologics OR=3.76), agreement on treatment (OR=4.57), having received information on treatment adaptation (OR=1.42) and the physician perception of patient trust (OR=1.58). These effects were independent of disease activity.RESULTS180 patients were recruited (77% women, mean age 60.8). The prevalence of adherence was 59.1% (95% CI 48.1% to 71.8%). Patients on biologics showed higher adherence and perceived a higher medication need than the others; patients on second-line DMARDs had experienced more adverse events than the others. The variables explaining adherence in the final multivariate model were the type of treatment prescribed (second-line DMARDs OR=5.22, and biologics OR=3.76), agreement on treatment (OR=4.57), having received information on treatment adaptation (OR=1.42) and the physician perception of patient trust (OR=1.58). These effects were independent of disease activity.Treatment adherence in RA is far from complete. Psychological, communicational and logistic factors influence treatment adherence in RA to a greater extent than sociodemographic or clinical factors.CONCLUSIONTreatment adherence in RA is far from complete. Psychological, communicational and logistic factors influence treatment adherence in RA to a greater extent than sociodemographic or clinical factors. Non-adherence challenges efficacy and costs of healthcare. Knowledge of the underlying factors is essential to design effective intervention strategies. To estimate the prevalence of treatment adherence in rheumatoid arthritis (RA) and to evaluate its predictors. A 6-month prospective cohort study of patients with RA selected by systematic stratified sampling (33% on first disease-modifying rheumatic drug (DMARD), 33% on second-line DMARD and 33% on biologics). The outcome measure was treatment adherence, defined by a score greater than 80% both in the Compliance Questionnaire in Rheumatology and the Reported Adherence to Medication scale, and was estimated with 95% CIs. Predictive factors included sociodemographic, psychological, clinical, drug-related, patient-doctor relationship related and logistic. Their effect on 6-month adherence was examined by multilevel logistic models adjusted for baseline covariates. 180 patients were recruited (77% women, mean age 60.8). The prevalence of adherence was 59.1% (95% CI 48.1% to 71.8%). Patients on biologics showed higher adherence and perceived a higher medication need than the others; patients on second-line DMARDs had experienced more adverse events than the others. The variables explaining adherence in the final multivariate model were the type of treatment prescribed (second-line DMARDs OR=5.22, and biologics OR=3.76), agreement on treatment (OR=4.57), having received information on treatment adaptation (OR=1.42) and the physician perception of patient trust (OR=1.58). These effects were independent of disease activity. Treatment adherence in RA is far from complete. Psychological, communicational and logistic factors influence treatment adherence in RA to a greater extent than sociodemographic or clinical factors.
Author	Courel, Laura Garrido Alperi, Mercedes Fábregas, Dolores Chaves, Lara Saenz de Buruaga, Joana Atxotegi Linaza, Alba Pérez Sivera, Francisca Restrepo, Juliana Carmona, Eugenio Chamizo Holgado, Susana Hernández, Laura Casas Balsa, Alejandro García de Yébenes, Maria Jesus García, Isabel Serrano Graell, Eduard Mendizábal, Javier Zavaleta, Nathali Rivas Álvarez, Beatriz González Etxebarrieta, Javier Duruelo Carmona, Loreto Rojas, Sara Varo, Fermín Medina Centeno, Antonio Gómez Morillo, Melania Martinez
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A comprehensive review publication-title: J Clin Pharm Ther doi: 10.1046/j.1365-2710.2001.00363.x – volume: 69 start-page: 631 year: 2010 ident: R39 article-title: Treating rheumatoid arthritis to target: recommendations of an international Task force publication-title: Ann Rheum Dis doi: 10.1136/ard.2009.123919 – volume: 12 start-page: 1151 year: 2018 ident: R27 article-title: Medication adherence and persistence in patients with autoimmune rheumatic diseases: a narrative review publication-title: Patient Prefer Adherence doi: 10.2147/PPA.S165101 – volume: 349 start-page: 151 year: 2015 ident: R29 article-title: Assessment of rheumatoid arthritis patients' adherence to treatment publication-title: Am J Med Sci doi: 10.1097/MAJ.0000000000000376 – volume: 6 start-page: e001432 year: 2020 ident: R31 article-title: Prevention, screening, assessing and managing of non-adherent behaviour in people with rheumatic and musculoskeletal diseases: systematic reviews Informing the 2020 EULAR points to consider publication-title: RMD Open doi: 10.1136/rmdopen-2020-001432 – volume: 24 start-page: 67 year: 1986 ident: R25 article-title: Concurrent and predictive validity of a self-reported measure of medication adherence publication-title: Med Care doi: 10.1097/00005650-198601000-00007 – volume: 38 start-page: 467 year: 2018 ident: R17 article-title: Spanish transcultural adaptation and validation of the English version of the compliance questionnaire in rheumatology publication-title: Rheumatol Int doi: 10.1007/s00296-018-3930-7 – volume: 6 Suppl 2 start-page: S19 year: 2004 ident: R12 article-title: Does route of administration affect the outcome of TNF antagonist therapy? 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A comprehensive review publication-title: J Clin Pharm Ther doi: 10.1046/j.1365-2710.2001.00363.x – volume: 8 start-page: 236 year: 2012 ident: 10.1136/annrheumdis-2021-221163_bib42 article-title: Management of rheumatoid arthritis in Spain (emAR II). clinical characteristics of the patients publication-title: Reumatol Clin doi: 10.1016/j.reuma.2012.03.009 – volume: 68 start-page: 1680 year: 2009 ident: 10.1136/annrheumdis-2021-221163_bib21 article-title: Elaboration of the preliminary rheumatoid arthritis impact of disease (raid) score: a EULAR initiative publication-title: Ann Rheum Dis doi: 10.1136/ard.2008.100271 – volume: 40 start-page: 1850 year: 2013 ident: 10.1136/annrheumdis-2021-221163_bib41 article-title: Orthopedic surgery in rheumatoid arthritis in the era of biologic therapy publication-title: J Rheumatol doi: 10.3899/jrheum.130118 – volume: 70 start-page: 935 year: 2011 ident: 10.1136/annrheumdis-2021-221163_bib22 article-title: Finalisation and validation of the rheumatoid arthritis impact of disease score, a patient-derived composite measure of impact of rheumatoid arthritis: a EULAR initiative publication-title: Ann Rheum Dis doi: 10.1136/ard.2010.142901 – volume: 69 start-page: 631 year: 2010 ident: 10.1136/annrheumdis-2021-221163_bib39 article-title: Treating rheumatoid arthritis to target: recommendations of an international Task force publication-title: Ann Rheum Dis doi: 10.1136/ard.2009.123919 – volume: 6 start-page: e001432 year: 2020 ident: 10.1136/annrheumdis-2021-221163_bib31 article-title: Prevention, screening, assessing and managing of non-adherent behaviour in people with rheumatic and musculoskeletal diseases: systematic reviews Informing the 2020 EULAR points to consider publication-title: RMD Open doi: 10.1136/rmdopen-2020-001432 – volume: 37 start-page: 1709 year: 2017 ident: 10.1136/annrheumdis-2021-221163_bib8 article-title: Adherence of rheumatoid arthritis patients to biologic disease-modifying antirheumatic drugs: a cross-sectional study publication-title: Rheumatol Int doi: 10.1007/s00296-017-3758-6 – volume: 62 start-page: 2569 year: 2010 ident: 10.1136/annrheumdis-2021-221163_bib14 article-title: 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against rheumatism collaborative initiative publication-title: Arthritis Rheum doi: 10.1002/art.27584
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Snippet	Non-adherence challenges efficacy and costs of healthcare. Knowledge of the underlying factors is essential to design effective intervention... Non-adherence challenges efficacy and costs of healthcare. Knowledge of the underlying factors is essential to design effective intervention strategies. To...
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StartPage	327
SubjectTerms	Antirheumatic Agents - therapeutic use Arthritis, Rheumatoid - drug therapy Arthritis, Rheumatoid - psychology Assessment of Medication Adherence Biological Products - therapeutic use Chronic illnesses Cohort analysis Comorbidity Decision making Disease Drug stores Female health care health services research Hospitals Humans Logistic Models Male Medication adherence Medication Adherence - psychology Middle Aged Multilevel Analysis outcome and process assessment patient care team Patient compliance Patients Pharmacy Physician-Patient Relations Professionals Prospective Studies Questionnaires Rheumatoid arthritis Rheumatology Sociodemographics
Title	Multilevel factors predict medication adherence in rheumatoid arthritis: a 6-month cohort study
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Volume	81
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