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Beukelman T, Su Y, Xie F, George MD, England BR, Curtis C, Clinton C, Stewart P, Curtis JR. Using Electronic Health Records and Linked Claims Data to Assess New Medication Use and Primary Nonadherence in Rheumatology Patients. Arthritis Care Res (Hoboken) 2024; 76:550-558. [PMID: 37909385 PMCID: PMC10963164 DOI: 10.1002/acr.25269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE The objective of this study was to determine the proportion of new medication prescriptions observed in electronic health records (EHR) that represent true incident medication use, accounting for undocumented previous prescriptions (prevalent medication use) and failure to initiate treatment (primary nonadherence) with linked administrative claims data as the reference standard. METHODS Using single-specialty rheumatology EHR data from more than 700 community practices in the United States linked to administrative claims data, we identified first (index) EHR prescriptions and assessed the positive predictive value (PPV) of different EHR-derived new user definitions to identify true incident use (no prior claims). We then assessed how often index EHR prescriptions that met a definition of new use resulted in primary nonadherence (no subsequent claims). RESULTS Overall, 12,405 index EHR prescriptions were identified with PPVs of 0.59 to 0.67 for true incident use. PPVs increased to 0.76 to 0.85 by excluding medications listed during the EHR medication reconciliation process and further increased to 0.87 to 0.93 by requiring ≥12 elapsed months since the first rheumatology office visit. Primary nonadherence at three months was observed in 33% to 38% overall and varied substantially by medication class, ranging from 15% to 23% for conventional synthetic disease-modifying antirheumatic drugs (DMARDs) to 54% to 64% for targeted synthetic DMARDs. CONCLUSION New DMARD use was accurately distinguished from prevalent use with EHR prescriptions and simple new user definitions that include current medications collected during medication reconciliation. Primary nonadherence was frequent and varied by DMARD class. This has important implications for epidemiologic studies using EHR data and for optimal delivery of clinical care.
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Affiliation(s)
- Timothy Beukelman
- Foundation for Science, Technology, Education, and Research, Birmingham, Alabama
| | - Yujie Su
- Illumination Health, Hoover, Alabama
| | | | | | - Bryant R England
- University of Nebraska Medical Center and Department of Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha
| | | | | | | | - Jeffrey R Curtis
- Foundation for Science, Technology, Education, and Research, Birmingham, Alabama, Illumination Health, Hoover, Alabama, and University of Alabama at Birmingham
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2
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Müller-Ladner U, Edwards CJ, Erkens A. International Survey to Evaluate Current Options for Subcutaneous Injection of Methotrexate (MTX) and a New Button-Free MTX Autoinjector. Patient Prefer Adherence 2024; 18:579-590. [PMID: 38463400 PMCID: PMC10924829 DOI: 10.2147/ppa.s440818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose Prefilled syringes (PFS) and various types of pens are available for subcutaneous injection of methotrexate (MTX) in patients with rheumatoid arthritis or moderate to severe psoriasis. A new MTX pen with modernized button-free autoinjection technology was developed as a successor to a button-activated pen (metoject®/metex® PEN). To assess the needs of users and the relevance of features of the new MTX autoinjector an international online survey was performed. Methods A structured questionnaire was distributed to physicians, nurses and patients in Germany, France, and the United Kingdom. Participants received illustrations and information about features of the new MTX autoinjector. Results In total, 189 rheumatologists, 111 dermatologists, 90 nurses, and 180 patients answered the questions. Specific reasons for a preference for the use of MTX pens over PFS could predominantly be assigned to the categories "dosing/administration" and "ease of use". The first impression of the new MTX autoinjector was positive in 82% of physicians, 87% of nurses, and 76% of patients, respectively. The four most important features of the new MTX autoinjector were 2-step autoinjector mechanism (receiving a mean 14.1 to 18.1 chips of a total of 100 chips), small injection volume (9.7 to 11.7 chips), 10 different doses for dose flexibility (8.0 to 13.2 chips), and short injection time below 5 seconds (8.5 to 11.1 chips). Conclusion Arguments for the use of MTX pens as opposed to PFS predominantly refer to dosing/administration and ease of use. The new button-free MTX autoinjector combines a number of advantageous features identified by the international survey.
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Affiliation(s)
- Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig-University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Christopher J Edwards
- Musculoskeletal Research Unit, NIHR Southampton Clinical Research Facility, University Hospital Southampton, Southampton, UK
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3
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Kibbons AM, Moore R, Choi L, Zuckerman AD. Patient-Tailored Interventions to Improve Specialty Medication Adherence: Results from a Prospective Randomized Controlled Trial. Am J Med 2023; 136:694-701.e1. [PMID: 37028694 PMCID: PMC10794990 DOI: 10.1016/j.amjmed.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Specialty medication nonadherence results in poor clinical outcomes and increased costs. This study evaluated the impact of patient-tailored interventions on specialty medication adherence. METHODS A pragmatic, randomized controlled trial was conducted at a single-center health-system specialty pharmacy from May 2019 to August 2021. Participants included recently nonadherent patients prescribed self-administered specialty medications from multiple specialty clinics. Eligible patients were stratified by historical clinic rates of nonadherence and randomized 1:1 to usual care or intervention arms. Intervention patients received patient-tailored interventions and 8 months of follow-up. A Wilcoxon test was used to analyze the difference in 6-, 8-, and 12-month post-enrollment adherence, calculated using proportion of days covered, between the intervention and usual care arms. RESULTS Four hundred and thirty eight patients were randomized. Baseline characteristics were similar between groups: mostly women (68%), white (82%), with a median age of 54 years (interquartile range, 40, 64). The most common reasons for nonadherence in the intervention arm were memory (37%) and unreachability (28%). There was a significant difference in median proportion of days covered between patients in the usual care and intervention arms at 8-months (0.88 vs 0.94, P < .001), 6-months (0.90 vs 0.95, P = .003), and 12-months post-enrollment (0.87 vs 0.93, P < .001). CONCLUSIONS Patient-tailored interventions resulted in significant specialty medication adherence improvement compared with standard of care. Specialty pharmacies should consider targeting nonadherent patients for adherence interventions.
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Affiliation(s)
| | - Ryan Moore
- Vanderbilt University Medical Center, Nashville, United States
| | - Leena Choi
- Vanderbilt University Medical Center, Nashville, United States
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4
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Marzaioli V, Canavan M, Donnelly A, Wade S, Fraser A, O'Sullivan T, Harney S, Ireland A, Veale DJ, Fearon U. Knowledge of disease, diagnosis, adherence and impact of research in an Irish cohort of patients with inflammatory arthritis. HRB Open Res 2023; 4:60. [PMID: 37250112 PMCID: PMC10213824 DOI: 10.12688/hrbopenres.13274.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 05/31/2023] Open
Abstract
Background: Patient engagement with clinicians results in shared decision making and increased adherence to medication. However, in order for strong patient: clinician partnerships to be achieved, communication barriers need to be identified. Therefore, the aim of this study was to examine the level of understanding of inflammatory arthritis patients and the need for strong patient-partnership in research. Methods: An online anonymous survey was distributed to patients living with inflammatory arthritis which addressed questions about diagnosis, routine tests, medications and how they work, medication adherence, disease flare, heredity, pregnancy, and patient involvement in research. Results: There were 1,873 respondents, 1416 of which had inflammatory arthritis (IA)- rheumatoid arthritis (RA) (65.8%) and psoriatic arthritis (PsA) (34.2%). They were predominantly female (RA 86%, PsA 85 %), aged 55±13 and 50±12 years. Less than 35% of patients had an understanding of diagnostic tests, what was measured and the implication for disease, with 75.5% also concerned about heredity. There was a high level of understanding of how specific medications treat inflammatory arthritis (72.9%). Adherence was also very high (>87%), with the main reasons for stopping medication without the advice of their clinician, 'feeling better' and 'side effects' however a significant proportion of patients (69.9%) reported a disease-flare following cessation of medication. Patients (31%) were also concerned that inflammatory arthritis reduced their chances of getting pregnant, with only 8% believing arthritis medications were safe to take during pregnancy. Finally, only 9% of patients had ever been asked to participate in a research study. Conclusions: This study demonstrates a need for the development of stronger patient-partnerships with clinicians and researchers in relation to patient education and engagement with research, to create a platform where patients can have meaningful input and involvement in future research studies.
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Affiliation(s)
- Viviana Marzaioli
- Molecular Rheumatology, Trinity College Dublin, Dublin, Ireland
- EULAR Centre of Excellence, Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital, Dublin, Dublin, Ireland
| | - Mary Canavan
- Molecular Rheumatology, Trinity College Dublin, Dublin, Ireland
- EULAR Centre of Excellence, Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital, Dublin, Dublin, Ireland
| | | | - Siobhan Wade
- Molecular Rheumatology, Trinity College Dublin, Dublin, Ireland
- EULAR Centre of Excellence, Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital, Dublin, Dublin, Ireland
| | | | | | - Sinead Harney
- Rheumatology Dept, Cork University Hospital, Cork, Ireland
| | | | - Douglas J. Veale
- EULAR Centre of Excellence, Centre for Arthritis and Rheumatic Diseases, St Vincent's University Hospital, Dublin, Dublin, Ireland
| | - Ursula Fearon
- Molecular Rheumatology, Trinity College Dublin, Dublin, Ireland
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5
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Neycheva S, Naseva E, Batalov Z, Karalilova R, Batalov A. Adherence to biological therapies in patients with rheumatoid arthritis: a retrospective cohort study. Rheumatol Int 2023; 43:1287-1296. [PMID: 37074381 DOI: 10.1007/s00296-023-05327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/08/2023] [Indexed: 04/20/2023]
Abstract
The advent of biologic disease-modifying antirheumatic drugs has dramatically changed the comprehensions of treatment and long-term prognosis in patients with rheumatoid arthritis. The potent therapeutic results can only be achieved if the patients adhere to prescribed medications. The objective of this study was to estimate the impact of age, gender, duration of the disease, concomitant Methotrexate therapy, prior exposure to biologic agents, disease activity, functional capacity, and health-related quality of life on adherence to biologic treatment among Bulgarian population with rheumatoid arthritis. This was a retrospective observational cohort study that included 179 patients. At the baseline visit and subsequent follow-up assessments at 6, 12, 24 and 36 months, patients were interviewed by a physician and underwent physical examinations. We monitored the changes in disease activity, functional capacity and health-related quality of life on each time point. Univariate and multivariate binary logistic regression was used to determine the prognostic value of possible predictors of treatment adherence. Our findings showed that only DAS28 score [odd ratio (OR) = 1.174; 95% CI 1.74-2.362] and HAQ score (OR 2.803; 95% CI 1.428-5.503) remained significant for the treatment adherence throughout the study period. The adherence to the biologic disease-modifying anti-rheumatic drugs among Bulgarian patients with rheumatoid arthritis is suboptimal. A multifaceted and comprehensive knowledge of the influencing factors can be useful for the development of different strategies that can improve treatment adherence.
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Affiliation(s)
- Stefka Neycheva
- Department of Rheumatology, Military Medical Academy, MHAT-Sofia, 3 Sveti Georgi Sofiyski Str., 1606, Sofia, Bulgaria.
| | - Emilia Naseva
- Faculty of Public Health "Prof. Tsekomir Vodenicharov, MD, DSc", Medical University of Sofia, 8 Byalo More Str., 1527, Sofia, Bulgaria
| | - Zguro Batalov
- Clinic of Rheumatology, UMHAT "Kaspela", Medical University of Plovdiv, 64 Sofia Str., 4000, Plovdiv, Bulgaria
| | - Rositsa Karalilova
- Clinic of Rheumatology, UMHAT "Kaspela", Medical University of Plovdiv, 64 Sofia Str., 4000, Plovdiv, Bulgaria
| | - Anastas Batalov
- Clinic of Rheumatology, UMHAT "Kaspela", Medical University of Plovdiv, 64 Sofia Str., 4000, Plovdiv, Bulgaria
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6
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Pouls BP, Bekker CL, van Dulmen S, Vriezekolk JE, van den Bemt BJ. A Serious Puzzle Game to Enhance Adherence to Antirheumatic Drugs in Patients With Rheumatoid Arthritis: Systematic Development Using Intervention Mapping. JMIR Serious Games 2022; 10:e31570. [PMID: 35179510 PMCID: PMC8900908 DOI: 10.2196/31570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/08/2021] [Accepted: 11/06/2021] [Indexed: 12/14/2022] Open
Abstract
Background Patients’ implicit attitudes toward medication need and concerns may influence their adherence. Targeting these implicit attitudes by combining game-entertainment with medication-related triggers might improve medication adherence in patients with rheumatoid arthritis (RA). Objective The aim of this study was to describe the systematic development of a serious game to enhance adherence to antirheumatic drugs by using intervention mapping. Methods A serious game was developed using the intervention mapping framework guided by a multidisciplinary expert group, which proceeded along 6 steps: (1) exploring the problem by assessing the relationship between medication adherence and implicit attitudes, (2) defining change objectives, (3) selecting evidence-based behavior change techniques that focused on adjusting implicit attitudes, (4) designing the intervention, (5) guaranteeing implementation by focusing on intrinsic motivation, and (6) planning a scientific evaluation. Results Based on the problem assessment and guided by the Dual-Attitude Model, implicit negative and illness-related attitudes of patients with RA were defined as the main target for the intervention. Consequently, the change objective was “after the intervention, participants have a more positive attitude toward antirheumatic drugs.” Attention bias modification, evaluative conditioning, and goal priming were the techniques chosen to implicitly target medication needs. These techniques were redesigned into medication-related triggers and built in the serious puzzle game. Thirty-seven patients with RA tested the game at several stages. Intrinsic motivation was led by the self-determination theory and addressed the 3 needs, that is, competence, autonomy, and relatedness. The intervention will be evaluated in a randomized clinical trial that assesses the effect of playing the serious game on antirheumatic drug adherence. Conclusions We systematically developed a serious game app to enhance adherence to antirheumatic drugs among patients with RA by using the intervention mapping framework. This paper could serve as a guideline for other health care providers when developing similar interventions.
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Affiliation(s)
- Bart Ph Pouls
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.,Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Johanna E Vriezekolk
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands
| | - Bart Jf van den Bemt
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
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7
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Panichaporn S, Chanapai W, Srisomnuek A, Thaweeratthakul P, Katchamart W. Validity and Reliability of the Thai Version of the 19-Item Compliance-Questionnaire-Rheumatology. Patient Prefer Adherence 2022; 16:2149-2158. [PMID: 36003800 PMCID: PMC9393110 DOI: 10.2147/ppa.s374445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/11/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To evaluate the psychometric properties and feasibility of the Thai version of Compliance-Questionnaire-Rheumatology (CQR)-19. PATIENTS AND METHODS A cross-sectional study was conducted in the Rheumatology clinic of Siriraj hospital from October 2020 to March 2022. Literate patients diagnosed with rheumatoid arthritis and aged ≥ 18 years old were included. Participants completed the Thai CQR-19 at baseline and during a follow-up visit. A pill count at the follow-up visit indicating that ≤ 80% of prescribed pills were taken was defined as poor compliance. Feasibility was assessed by the time to completion and the number of missing questions. RESULTS 156 participants were enrolled and 88% were in good compliance. The sensitivity of the CQR-19 to detect good compliance was 78.2% and the specificity was 27.8%. The Thai CQR-19 showed moderate agreement (Gwet's AC1= 0.61, p < 0.01) with 72.2% agreement against pill counts. The Thai CQR-19 had good internal consistency (Cronbach's alpha = 0.83) with moderate test-retest reliability (intraclass coefficients = 0.64, 95% CI 0.54-0.73; p < 0.05). There was a weak correlation between the Thai CQR-19 and disease activity (rs = 0.20, p < 0.05), and no correlation with functional disability (rs = 0.09, p = 0.25). The median (IQR) completion time was 4.42 (3.25-6.16) minutes and 114 (73%) completed all 19 questions. CONCLUSION The Thai version of CQR-19 is a valid and reliable tool to assess medication compliance in Thai patients with RA. To ensure completeness and accuracy, this questionnaire may be administered by interview.
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Affiliation(s)
- Saranya Panichaporn
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanwisa Chanapai
- Division of Clinical Trials, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ananya Srisomnuek
- Division of Clinical Trials, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phakhamon Thaweeratthakul
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanruchada Katchamart
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Wanruchada Katchamart, Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand, Tel +66 2 419 7775, Fax +66 2 418 3222, Email
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8
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Nagy G, Roodenrijs NMT, Welsing PMJ, Kedves M, Hamar A, van der Goes MC, Kent A, Bakkers M, Pchelnikova P, Blaas E, Senolt L, Szekanecz Z, Choy EH, Dougados M, Jacobs JW, Geenen R, Bijlsma JW, Zink A, Aletaha D, Schoneveld L, van Riel P, Dumas S, Prior Y, Nikiphorou E, Ferraccioli G, Schett G, Hyrich KL, Mueller-Ladner U, Buch MH, McInnes IB, van der Heijde D, van Laar JM. EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2021; 81:20-33. [PMID: 34407926 PMCID: PMC8761998 DOI: 10.1136/annrheumdis-2021-220973] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/23/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop evidence-based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult-to-treat rheumatoid arthritis (D2T RA). METHODS An EULAR Task Force was established comprising 34 individuals: 26 rheumatologists, patient partners and rheumatology experienced health professionals. Two systematic literature reviews addressed clinical questions around diagnostic challenges, and pharmacological and non-pharmacological therapeutic strategies in D2T RA. PtCs were formulated based on the identified evidence and expert opinion. Strength of recommendations (SoR, scale A-D: A typically consistent level 1 studies and D level 5 evidence or inconsistent studies) and level of agreement (LoA, scale 0-10: 0 completely disagree and 10 completely agree) of the PtCs were determined by the Task Force members. RESULTS Two overarching principles and 11 PtCs were defined concerning diagnostic confirmation of RA, evaluation of inflammatory disease activity, pharmacological and non-pharmacological interventions, treatment adherence, functional disability, pain, fatigue, goal setting and self-efficacy and the impact of comorbidities. The SoR varied from level C to level D. The mean LoA with the overarching principles and PtCs was generally high (8.4-9.6). CONCLUSIONS These PtCs for D2T RA can serve as a clinical roadmap to support healthcare professionals and patients to deliver holistic management and more personalised pharmacological and non-pharmacological therapeutic strategies. High-quality evidence was scarce. A research agenda was created to guide future research.
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Affiliation(s)
- György Nagy
- Department of Rheumatology & Clinical Immunology, Semmelweis University, Budapest, Hungary .,Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Nadia M T Roodenrijs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Melinda Kedves
- Bács-Kiskun County Hospital, Rheumatology Department, Kecskemét, Hungary
| | - Attila Hamar
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marlies C van der Goes
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Rheumatology, Meander Medical Center, Amersfoort, The Netherlands
| | - Alison Kent
- Salisbury Foundation Trust NHS Hospital, Wiltshire, UK
| | - Margot Bakkers
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Polina Pchelnikova
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Etienne Blaas
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ladislav Senolt
- Department of Rheumatology, 1st Faculty of Medicine, Charles University and Institute of Rheumatology, Prague, Czech Republic
| | - Zoltan Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ernest H Choy
- CREATE Centre, Section of Rheumatology, School of Medicine, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Maxime Dougados
- Université de Paris Department of Rheumatology - Hôpital Cochin. Assistance Publique - Hôpitaux de Paris INSERM (U1153) Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Johannes Wg Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Johannes Wj Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Daniel Aletaha
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Leonard Schoneveld
- Department of Rheumatology, Bravis Hospital, Roosendaal, The Netherlands
| | - Piet van Riel
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sophie Dumas
- Department of Pharmacy, Marin Hospital, Asisstance Publique-Hopitaux de Paris, Hendaye, France
| | - Yeliz Prior
- School of Health and Society, Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK.,Rheumatology Department, King's College Hospital, London, UK
| | | | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Kimme L Hyrich
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Maya H Buch
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.,Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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9
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Salmasi S, Kelly A, Bartlett SJ, de Wit M, March L, Tong A, Tugwell P, Tymms K, Verstappen S, De Vera MA. Researchers' perspectives on methodological challenges and outcomes selection in interventional studies targeting medication adherence in rheumatic diseases: an OMERACT-adherence study. BMC Rheumatol 2021; 5:26. [PMID: 34233761 PMCID: PMC8265120 DOI: 10.1186/s41927-021-00193-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background Research on adherence interventions in rheumatology is limited by methodological issues, particularly heterogeneous outcomes. We aimed to describe researchers’ experiences with conducting interventional studies targeting medication adherence in rheumatology and their perspectives on establishing core outcomes. Methods Semi-structured interviews using audio conference were conducted with researchers who had conducted an adherence study of any design in the past 10 years. Data collection and thematic analysis were performed iteratively, until saturation. Results We interviewed 13 researchers, most of whom worked in academia and specialized in epidemiology and/or health services research. We identified three themes: 1) improving measurement of adherence (considering all phases of adherence, using appropriate and relevant measures, and establishing clinically meaningful thresholds); 2) challenges in designing and appraising adherence intervention studies (considering the confusion over a plethora of outcomes, difficulties with powering studies to demonstrate meaningful changes, and suboptimal descriptions of adherence interventions in published studies); and 3) advancing outcome assessment in adherence intervention studies (capturing rationale for developing a core domain set as well as recommendations and anticipated challenges by participants). Conclusions Uniquely gathering perspectives from international adherence researchers, our findings led to researcher-informed recommendations for improving adherence research including specifying the targeted adherence phase in designing interventions and studies and providing a glossary of terms to promote consistency in reporting. We also identified recommendations for developing a core domain set for interventional studies targeting medication adherence including involvement of patients, clinicians, and other stakeholders and methodological and practical considerations to establish rigor and support uptake. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-021-00193-4.
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Affiliation(s)
- Shahrzad Salmasi
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Arthritis Research Canada, Richmond, Canada
| | - Ayano Kelly
- 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
| | - Susan J Bartlett
- Department of Medicine, McGill University and Research Institute, McGill University Health Centres, Montreal, Canada.,Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Maarten de Wit
- OMERACT Patient Research Partner, Amsterdam, Netherlands
| | - Lyn March
- 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
| | - Allison Tong
- 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
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathleen Tymms
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia.,Canberra Rheumatology, Canberra, ACT, Australia.,Department of Rheumatology, Canberra Hospital, Canberra, ACT, Australia
| | - Suzanne Verstappen
- 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, Manchester, UK
| | - Mary A De Vera
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Arthritis Research Canada, Richmond, Canada.
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10
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Marzaioli V, Canavan M, Donnolly A, Wade S, Fraser A, O'Sullivan T, Harney S, Ireland A, Veale DJ, Fearon U. Knowledge of disease, diagnosis, adherence and impact of research in an Irish cohort of patients with inflammatory arthritis. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13274.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Patient engagement with clinicians results in shared decision making and increased adherence to medication. However, in order for strong patient: clinician partnerships to be achieved, communication barriers need to be identified. Therefore, the aim of this study was to examine the level of understanding of inflammatory arthritis patients and the need for strong patient-partnership in research. Methods: An online anonymous survey was distributed to patients living with inflammatory arthritis which addressed questions about diagnosis, routine tests, medications and how they work, medication adherence, disease flare, heredity, pregnancy, and patient involvement in research. Results: There were 1,873 respondents, 1416 of which had inflammatory arthritis (IA)- rheumatoid arthritis (RA) (65.8%) and psoriatic arthritis (PsA) (34.2%). They were predominantly female (RA 86%, PsA 85 %), aged 55±13 and 50±12 years. Less than 35% of patients had an understanding of diagnostic tests, what was measured and the implication for disease, with 75.5% also concerned about heredity. There was a high level of understanding of how specific medications treat inflammatory arthritis (72.9%). Adherence was also very high (>87%), with the main reasons for stopping medication without the advice of their clinician, ‘feeling better’ and ‘side effects’ however a significant proportion of patients (69.9%) reported a disease-flare following cessation of medication. Patients (31%) were also concerned that inflammatory arthritis reduced their chances of getting pregnant, with only 8% believing arthritis medications were safe to take during pregnancy. Finally, only 9% of patients had ever been asked to participate in a research study. Conclusions: This study demonstrates a need for the development of stronger patient-partnerships with clinicians and researchers in relation to patient education and engagement with research, to create a platform where patients can have meaningful input and involvement in future research studies.
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11
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van Heuckelum M, van den Ende CHM, van Dulmen S, van den Bemt BJF. Electronic Monitoring Feedback for Improving Medication Adherence and Clinical Outcomes in Early Rheumatoid Arthritis: A Randomized Clinical Trial. Patient Prefer Adherence 2021; 15:1107-1119. [PMID: 34079231 PMCID: PMC8164714 DOI: 10.2147/ppa.s297170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/19/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Non-adherence to medication (range 30-107%) is a major issue in patients with rheumatoid arthritis (RA). Previous research has shown that electronic monitoring feedback (EMF) might be an effective strategy to improve medication adherence in chronic conditions. Therefore, this study investigated the effectiveness of electronic monitoring feedback in patients with early RA to improve medication adherence and clinical outcomes compared to usual care. METHODS An open-label randomized clinical trial was performed to compare EMF with standard care during a 12-month follow-up period on two sites of the Sint Maartenskliniek (Nijmegen and Boxmeer) in the Netherlands. Patients were eligible if they: (1) had a (working) diagnosis of early RA, (2) were currently using methotrexate, (3) were aged ≥18 years, and (4) had a life expectancy of ≥12 months. Primary outcome was the difference in proportion of non-adherent patients measured with the Compliance Questionnaire on Rheumatology after 12 months. Secondary outcomes were beliefs about medicines, medication adherence measured with the MMAS-8®, patients' health status, prescription of biologic DMARDs, and disease activity after 12 months. RESULTS Of the 367 initially-invited patients, 93 patients with early RA agreed to participate in this study. No significant difference was found in the proportion of non-adherent patients between the intervention arm and the usual care arm after 12 months follow-up (60.0% and 61.3%, p=0.93, respectively). Patients in the intervention arm tended to discontinue methotrexate earlier than patients in the usual care arm (median time in weeks: 15.7 (9.1-33.6) and 21.9 (19-28.4), respectively, p=0.31), whereas patients in the usual care arm tended to initiate biologic DMARDs earlier than those in the intervention arm (median time in weeks: 11.9 (5.7-22) and 17 (9.9-40.9), respectively, p=0.55). CONCLUSION This study illustrates the challenge of targeting non-adherence with EMF in patients with early RA and shares important lessons learned about designing adherence intervention trials with respect to study attrition, accounting for drug survival, intervention fidelity, intervention uptake, and technical aspects.
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Affiliation(s)
- Milou van Heuckelum
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sandra van Dulmen
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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12
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Evans C, Marrie RA, Yao S, Zhu F, Walld R, Tremlett H, Blackburn D, Kingwell E. Medication adherence in multiple sclerosis as a potential model for other chronic diseases: a population-based cohort study. BMJ Open 2021; 11:e043930. [PMID: 33550262 PMCID: PMC7925877 DOI: 10.1136/bmjopen-2020-043930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To determine whether better medication adherence in multiple sclerosis (MS) might be due to specialised disease-modifying drug (DMD) support programmes by: (1) establishing higher adherence in MS than in other chronic diseases and (2) determining if higher adherence is associated with patient-specific or treatment-specific factors. DESIGN Retrospective cohort study with data from 1 January 1996 to 31 December 2015. SETTING Population-based health administrative data from three Canadian provinces. PARTICIPANTS Individual cohorts were created using validated case definitions for MS, epilepsy, Parkinson's disease (PD) and rheumatoid arthritis (RA). Subjects were included if they received ≥1 dispensation for a disease-related drug between 1 January 1997 and 31 December 2014. MAIN OUTCOME MEASURES Proportion of subjects with optimal adherence (≥80%) measured by the medication possession ratio 1 year after the index date (first dispensation of disease-related drug). RESULTS 126 478 subjects were included in the primary analysis (MS, n=6271; epilepsy, n=55 739; PD, n=21 304; RA, n=43 164). Subjects with epilepsy (adjusted OR, aOR 0.29; 95% CI 0.19 to 0.45), PD (aOR 0.42; 95% CI 0.29 to 0.63) or RA (aOR 0.26; 95% CI 0.19 to 0.35) were less likely to have optimal 1-year adherence compared with subjects with MS. Within the MS cohort, adherence was higher for DMD than for chronic-use non-MS medications, and no consistent patient-related predictors of adherence were observed across all four non-MS medication classes, including having optimal adherence to DMD. CONCLUSIONS Subjects with MS were significantly more likely to have optimal 1-year adherence than subjects with epilepsy, RA and PD, and optimal adherence appears related to treatment-specific factors rather than patient-related factors. This supports the hypothesis that higher adherence to the MS DMDs could be due to the specialised support programmes; these programmes may serve as a model for use in other chronic conditions.
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Affiliation(s)
- Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ruth Ann Marrie
- Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shenzhen Yao
- Saskatchewan Health Quality Council, Saskatoon, Saskatchewan, Canada
| | - Feng Zhu
- Neurology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Helen Tremlett
- Neurology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - David Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Elaine Kingwell
- Neurology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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13
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Kelly A, Tymms K, Fallon K, Sumpton D, Tugwell P, Tunnicliffe D, Tong A. Qualitative Research in Rheumatology: An Overview of Methods and Contributions to Practice and Policy. J Rheumatol 2021; 48:6-15. [PMID: 32669447 DOI: 10.3899/jrheum.191368] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2020] [Indexed: 12/12/2022]
Abstract
Patient-centered care is widely advocated in rheumatology. This involves collaboration among patients, caregivers, and health professionals and is particularly important in chronic rheumatic conditions because the disease and treatment can impair patients' health and well-being. Qualitative research can systematically generate insights about people's experiences, beliefs, and attitudes, which patients may not always express in clinical settings. These insights can address complex and challenging areas in rheumatology, such as treatment adherence and transition to adult healthcare services. Despite this, qualitative research comprises 1% of studies published in top-tier rheumatology journals. A better understanding about the effect and role, methods, and rigor of qualitative research is needed. This overview highlights the recent contributions of qualitative research in rheumatology, summarizes the common approaches and methods used, and outlines the key principles to guide appraisal of qualitative studies.
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Affiliation(s)
- Ayano Kelly
- A. Kelly, MBBS, FRACP, College of Health and Medicine, Australian National University, Canberra, and Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, and Canberra Rheumatology, Canberra, and Department of Rheumatology, The Canberra Hospital, Canberra, Australia;
| | - Kathleen Tymms
- K. Tymms, MBBS, FRACP, College of Health and Medicine, Australian National University, and Canberra Rheumatology, and Department of Rheumatology, The Canberra Hospital, Canberra, Australia
| | - Kieran Fallon
- K. Fallon, FACSEP, College of Health and Medicine, Australian National University, and Department of Rheumatology, The Canberra Hospital, Canberra, Australia
| | - Daniel Sumpton
- D. Sumpton, MBBS, FRACP, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, and Department of Rheumatology, Concord Hospital, Sydney, Australia
| | - Peter Tugwell
- P. Tugwell, MD, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Tunnicliffe
- D. Tunnicliffe, PhD, A. Tong, PhD, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Allison Tong
- D. Tunnicliffe, PhD, A. Tong, PhD, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
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14
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Kuusalo L, Sokka-Isler T, Kautiainen H, Ekman P, Kauppi MJ, Pirilä L, Rannio T, Uutela T, Yli-Kerttula T, Puolakka K. Automated Text Message-Enhanced Monitoring Versus Routine Monitoring in Early Rheumatoid Arthritis: A Randomized Trial. Arthritis Care Res (Hoboken) 2020; 72:319-325. [PMID: 30740935 DOI: 10.1002/acr.23846] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 02/05/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Frequent monitoring of patients with early rheumatoid arthritis (RA) is required for achieving good outcomes. This study was undertaken to investigate the influence of text message (SMS)-enhanced monitoring on early RA outcomes. METHODS We randomized 166 patients with early, disease-modifying antirheumatic drug-naive RA to receive SMS-enhanced follow-up or routine care. All patients attended visits at 0, 3, and 6 months, and a follow-up visit at 12 months. Treatment was at the physicians' discretion. The intervention included 13 SMSs during weeks 0-24 with questions concerning medication problems (yes/no) and disease activity (patient global assessment [PtGA], scale 0-10). Patients were contacted if response SMSs indicated medication problems or PtGA exceeded predefined thresholds. Primary outcome was 6-month Boolean remission (no swollen or tender joints and normal C-reactive protein levels). Quality of life (QoL; measured by the Short Form 36 survey) and Disease Activity Score in 28 joints (DAS28) were assessed. RESULTS Six and 12-month follow-up data were available for 162 and 157 patients, respectively. In the intervention group, 46% of the patients (38 of 82) reported medication problems and 49% (40 of 82) reported text message PtGAs above the alarm limit. Remission rates at 6 months (P = 0.34) were 51% in the intervention group and 42% in the control group. These rates were 57% and 43% at 12 months (P = 0.17) in the intervention and control groups, respectively. The respective mean ± SD DAS28 scores for the intervention and control groups were 1.92 ± 1.12 and 2.22 ± 1.11 at 6 months (P = 0.09); and 1.79 ± 0.91 and 2.08 ± 1.22 at 12 months (P = 0.28). No differences in QoL were observed. CONCLUSION The study did not meet the primary outcome despite a trend favoring the intervention group. This may be explained by the notably high overall remission rates.
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Affiliation(s)
- Laura Kuusalo
- Turku University Hospital and University of Turku, Turku, Finland
| | | | - Hannu Kautiainen
- University of Eastern Finland, Kuopio, Finland, and Folkhälsan Research Center, Helsinki, Finland
| | | | | | - Laura Pirilä
- Turku University Hospital and University of Turku, Turku, Finland
| | | | | | | | - Kari Puolakka
- South Karelia Central Hospital, Lappeenranta, Finland
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15
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Hope HF, Hyrich KL, Anderson J, Bluett J, Sergeant JC, Barton A, Cordingley L, Verstappen SMM. The predictors of and reasons for non-adherence in an observational cohort of patients with rheumatoid arthritis commencing methotrexate. Rheumatology (Oxford) 2020; 59:213-223. [PMID: 31302692 DOI: 10.1093/rheumatology/kez274] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/24/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE In order to develop interventions to optimize MTX use for the treatment of RA we evaluated the rate of, reasons for and predictors of MTX non-adherence during the first 6 months of therapy. METHODS The Rheumatoid Arthritis Medication Study (RAMS) is a prospective multicentre cohort study of incident MTX users in the UK. Prior to MTX commencement demographic, clinical and psychological data were collected. A weekly patient-completed diary recorded MTX dose, possible side effects and adherence over 26 weeks. The number of non-adherent weeks was calculated. Potential baseline predictors of ever non-adherence (⩾1 week non-adherent) during the first 6 months of MTX therapy were identified using logistic regression analyses. RESULTS 606 patients with RA were included; 69% female, mean (s.d.) age 60 (13) years and DAS28 score 4.2 (1.2). Over the first 6 months following MTX initiation, 158 (26%) patients were ever non-adherent (71% intentional, 19% non-intentional, 10% unexplained) and mean (s.d.) number of non-adherent weeks was 2.5 (2.1). Multivariable predictors of ever non-adherence included DAS28 [odds ratios (OR) 1.1, 95% CI 1.0, 1.4], fatigue (OR 1.1, 95% CI 1.0, 1.2 per cm), ⩾2 comorbidities vs no comorbidities (OR 1.9, 95% CI 1.1, 3.5) and high medication concerns despite perceived need (OR 1.1, 95% CI 1.0, 1.1 per unit decrease in need/concern differential). CONCLUSION This is the largest study evaluating early intentional and non-intentional non-adherence to MTX, which has identified that patient beliefs and multi-morbidity strongly link with non-adherence. These findings can direct the design of and provide potential targets for interventions to improve patient adherence.
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Affiliation(s)
- Holly F Hope
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kimme L Hyrich
- NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Arthritis Research UK Centre for Epidemiology, Manchester, UK
| | - James Anderson
- Arthritis Research UK Centre for Genetics and Genomics, Faculty of Biology, Medicine and Health, Manchester, UK
| | - James Bluett
- NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Arthritis Research UK Centre for Genetics and Genomics, Faculty of Biology, Medicine and Health, Manchester, UK
| | - Jamie C Sergeant
- Arthritis Research UK Centre for Epidemiology, Manchester, UK.,Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Anne Barton
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Arthritis Research UK Centre for Genetics and Genomics, Faculty of Biology, Medicine and Health, Manchester, UK
| | - Lis Cordingley
- NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Arthritis Research UK Centre for Epidemiology, Manchester, UK
| | - Suzanne M M Verstappen
- NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Arthritis Research UK Centre for Epidemiology, Manchester, UK
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16
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Mary A, Boursier A, Desailly Henry I, Grados F, Séjourné A, Salomon S, Fardellone P, Brazier M, Goëb V. Mobile Phone Text Messages and Effect on Treatment Adherence in Patients Taking Methotrexate for Rheumatoid Arthritis: A Randomized Pilot Study. Arthritis Care Res (Hoboken) 2020; 71:1344-1352. [PMID: 30192070 DOI: 10.1002/acr.23750] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 09/04/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To assess the impact of weekly text messages on adherence in patients taking methotrexate (MTX) for rheumatoid arthritis (RA). METHODS This prospective, randomized pilot, single-site study included patients with RA stabilized using MTX alone or combined with biologics. Participants were randomized to 3 interventions: a standard consultation (controls), a 15-minute pharmacist-led counseling session, or the receipt of text message reminders. The change over time in the Compliance Questionnaire Rheumatology (CQR-19) score between baseline and 6 months was defined as the primary outcome for adherence. Multivariable analyses and final adherence (as a composite outcome of the CQR-19 score, the Girerd score, and the medication possession ratio) were probed in sensitivity tests. Rheumatologic scales, inflammation, and patient satisfaction were also analyzed. RESULTS A total of 96 patients (mean ± SD Disease Activity Score in 28 joints 2.42 ± 1.03) were monitored. The change over time in the CQR-19 score was significantly higher in the text message group (mean ± SD 3.32 ± 5.66; P = 0.02) than in the control group (mean ± SD 0.22 ± 6.56) and the pharmacist-led counseling group (mean ± SD -0.14 ± 7.56). Multivariable logistic regression showed that text messages remained associated with an increase in the CQR-19 score, independently of the baseline CQR-19 score (odds ratio 3.63 [95% confidence interval 1.26-10.49]; P = 0.017). In the text message group, the increase in the CQR-19 score was correlated with the Health Assessment Questionnaire score (r = -0.405, P = 0.021), and patient satisfaction was significantly higher (P < 0.01) than in the control group. CONCLUSION Our results showed evidence of a positive impact of text messages on adherence to MTX treatment for RA. The clinical benefit and the ideal target patient remain to be determined.
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Affiliation(s)
- Aurélien Mary
- Amiens Picardie University Hospital, Inserm 1088, and Picardie Jules Verne University, Amiens, France
| | | | | | | | | | | | - Patrice Fardellone
- Inserm 1088, Picardie Jules Verne University, and Amiens Picardie University Hospital, Amiens, France
| | - Michel Brazier
- Amiens Picardie University Hospital, Inserm 1088, and Picardie Jules Verne University, Amiens, France
| | - Vincent Goëb
- Picardie Jules Verne University, and EA 4666, Amiens, France
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17
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Pouls BPH, Kristensen LE, Petersson M, van den Bemt BJF, Ballerini L, Bruggraber R, Karlen H, Mountian I, van Bracht E, Wiegratz S, Jørgensen TS. A pilot study examining patient preference and satisfaction for ava®, a reusable electronic injection device to administer certolizumab pegol. Expert Opin Drug Deliv 2020; 17:705-711. [PMID: 32154740 DOI: 10.1080/17425247.2020.1736552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Anti-tumor necrosis factor (anti-TNF) adherence is suboptimal. ava®, a reusable electromechanical self-injection device (e-Device) developed for certolizumab pegol (CZP) administration, aims to overcome some barriers to increase adherence. This study evaluates patient experience of the e-Device and its training materials and determines patient device preference.Methods: CZP-treated patients were recruited from the Netherlands, Denmark and Sweden. Patients completed a pre-injection Assessment of Self-Injection (ASI) questionnaire investigating self-injection perception. After training, patients administered 3 consecutive self-injections using the e-Device, patient experience of each was assessed using the post-injection ASI. An additional questionnaire evaluated training materials. After Injection 3, patients indicated their preference: the e-Device or their previous device.Results: 59 patients participated; most rated the e-Device highly for satisfaction, self-confidence and ease of use. The (negative) feelings and pain and skin reactions domains had low ratings. Post-injection ASI domain scores were similar following each of the 3 e-Device injections. Training materials were rated highly (video: 8.4/10; step-by-step guide: 8.4/10). 57.1% (32/56) patients preferred the e-Device over their previous self-injection device.Conclusions: Patients were satisfied with the e-Device and most preferred it over other self-injection devices. By improving patient experience, the e-Device may help increase medication adherence.
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Affiliation(s)
- Bart P H Pouls
- Sint Maartenskliniek, Nijmegen, Netherlands.,Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lars E Kristensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Marianne Petersson
- Department of Molecular and Clinical Medicine, Linköping University, Linköping, Sweden
| | - B J F van den Bemt
- Sint Maartenskliniek, Nijmegen, Netherlands.,Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | | | | | | | - Tanja S Jørgensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
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18
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Hirsh J, Wood P, Keniston A, Boyle D, Quinzanos I, Caplan L, Davis L. Universal Health Literacy Precautions Are Associated With a Significant Increase in Medication Adherence in Vulnerable Rheumatology Patients. ACR Open Rheumatol 2020; 2:110-118. [PMID: 31957348 PMCID: PMC7011426 DOI: 10.1002/acr2.11108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/07/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Our objective was to determine the impact of the Health Literacy Universal Precautions Toolkit, adapted for rheumatology, on medication adherence, patient satisfaction, and feasibility in all patients; its effect on the clinical disease activity index (CDAI) was studied in a rheumatoid arthritis (RA) subpopulation. METHODS Data collected during a 6-month prospective quality assurance intervention was compared with data from a prior 6-month period. Interventions included 1) encouraging questions, 2) teach-back communication, and 3) brown-bag medication review. Analysis was performed using linear regression or generalized estimating equation (GEE) regression. RESULTS During the intervention period, 46 physicians completed 1737 patient visits. Questions were encouraged, and teach-back communication was performed in more than 90% of visits. Brown-bag medication reviews were performed in 47% of visits overall and 69% of visits in a subgroup that received additional reminder calls. Visit duration and patient satisfaction were not significantly increased. Adherence for rheumatology-related medications that were prescribed both before and during the intervention increased by 22% (P ≤ 0.001; by GEE). Teach-back communication predicted a statistically significant improvement in medication adherence in this subpopulation (by linear regression). The mean CDAI did not improve; however, African American race and Hispanic ethnicity were associated with a decreased CDAI (by GEE). CONCLUSION Implementation of the Health Literacy Universal Precautions Toolkit, adapted for rheumatology, improved medication adherence in our safety-net clinic, with particularly strong effects seen with teach-back communication. In certain populations, use of the toolkit may also improve RA disease activity. This is the first study to document improved medication adherence with this intervention in a real-world setting.
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Affiliation(s)
- Joel Hirsh
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Patrick Wood
- Denver Veterans Affairs and Medical Center, University of Colorado Medical School, Aurora, Colorado
| | - Angela Keniston
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Dennis Boyle
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Itziar Quinzanos
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
| | - Liron Caplan
- Denver Veterans Affairs and Medical Center, University of Colorado Medical School, Aurora, Colorado
| | - Lisa Davis
- Denver Health and Hospital Authority, University of Colorado Medical School, Denver, Aurora, Colorado
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19
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Zeitoun JD, Morvan Y. Patients' Perceptions and Preferences Regarding Two Different Forms of Methotrexate Autoinjectors for Moderate to Severe Rheumatoid Arthritis: A European Crossover Survey. Patient Prefer Adherence 2020; 14:2177-2185. [PMID: 33177812 PMCID: PMC7650003 DOI: 10.2147/ppa.s269575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Treatment adherence is crucial in patients with rheumatoid arthritis (RA). The device used by the patients for self-injections may influence adherence to methotrexate (MTX) treatment. A MTX-autoinjector has been recently marketed in Europe. This crossover survey compared this MTX-autoinjector (MTX-autoinjector A) and an already existing MTX-autoinjector (MTX-autoinjector B) from the patients' perspective. PATIENTS AND METHODS A total of 100 patients with moderate to severe RA using MTX-autoinjector A (N=35) or MTX-autoinjector B (N=65) were interviewed by an independent Global Market Research Company. Face-to-face interviews were performed using a computer-assisted personal interview system. Evaluation of the unfamiliar MTX-autoinjector was performed once the patients had received information, seen a demonstration, and performed a virtual testing. RESULTS A substantial advantage in favor of the MTX-autoinjector A was found with respect to all surveyed indicators. Respectively, 95% and 55% of the users of MTX-autoinjectors A and B claimed to be very or totally satisfied with their familiar MTX-autoinjector. With respect to several specific characteristics, 91% and 60% of the users of MTX-autoinjectors A and B were very or totally satisfied with their familiar MTX-autoinjector, 29% and 77% found the unfamiliar MTX-autoinjector better, and 26% and 73% were interested in trying the unfamiliar MTX-autoinjector. Injection mode (with no push button) and end-of-injection recognition system (with audible signal) were identified as key features explaining a stronger preference for MTX-autoinjector A. CONCLUSION Even though deserving further studying, these findings are expected to guide clinicians when prescribing or renewing prescription of MTX-autoinjector, in particular in poor or non-compliant patients. In a context of growing interest in shared decision-making, the objective would be to choose with each patient the best suited MTX-autoinjector, and ultimately, to obtain a better treatment adherence.
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Affiliation(s)
- Jean-David Zeitoun
- Département de Gastroentérologie et Nutrition, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris75012, France
| | - Yves Morvan
- IPSOS Healthcare Department, Paris75013, France
- Correspondence: Yves Morvan IPSOS Healthcare Department, 35 rue du Val de Marne, Paris75013, FranceTel +33 1 41 98 93 44Fax +33 1 41 98 99 99 Email
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Kelly A, Crimston-Smith L, Tong A, Bartlett SJ, Bekker CL, Christensen R, De Vera MA, de Wit M, Evans V, Gill M, March L, Manera K, Nieuwlaat R, Salmasi S, Scholte-Voshaar M, Singh JA, Sumpton D, Toupin-April K, Tugwell P, van den Bemt B, Verstappen S, Tymms K. Scope of Outcomes in Trials and Observational Studies of Interventions Targeting Medication Adherence in Rheumatic Conditions: A Systematic Review. J Rheumatol 2019; 47:1565-1574. [PMID: 31839595 DOI: 10.3899/jrheum.190726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Nonadherence 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 prespecified 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 3 phases: initiation (n = 13 studies, 25%), implementation (n = 32, 60%), persistence (n = 27, 51%), and 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.
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Affiliation(s)
- Ayano Kelly
- A. Kelly, Clinical Associate Lecturer, Australian National University, MBBS, FRACP, College of Health and Medicine, Australian National University, and Canberra Rheumatology, Canberra, and Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia;
| | - Luke Crimston-Smith
- L. Crimston-Smith, BN, College of Health and Medicine, Australian National University, and Canberra Rheumatology, Canberra, Australia
| | - Allison Tong
- A. Tong, PhD, Professor, K. Manera, MIPH, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Susan J Bartlett
- S.J. Bartlett, PhD, Professor, Department of Medicine, McGill University and Research Institute, McGill University Health Centres, Montreal, Quebec, Canada, and Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Charlotte L Bekker
- C.L. Bekker, PhD, Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Robin Christensen
- R. Christensen, PhD, Professor of Biostatistics and Clinical Epidemiology, Musculoskeletal Statistics Unit, the Parker Institute, Copenhagen University Hospital, Copenhagen, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Mary A De Vera
- M.A. De Vera, PhD, Assistant Professor, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Maarten de Wit
- M. de Wit, PhD, OMERACT Patient Research Partner, the Netherlands
| | - Vicki Evans
- V. Evans, PhD, Clear Vision Consulting, Canberra, and OMERACT Patient Research Partner, and Discipline of Optometry, University of Canberra, Canberra, Australia
| | - Michael Gill
- M. Gill, BA, Dragon Claw, Sydney, Australia, and OMERACT Patient Research Partner
| | - Lyn March
- L. March, PhD, Professor, Institute of Bone and Joint Research, Kolling Institute of Medical Research, and Department of Rheumatology, Royal North Shore Hospital, and Northern Clinical School, The University of Sydney, Sydney, Australia
| | - Karine Manera
- A. Tong, PhD, Professor, K. Manera, MIPH, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Robby Nieuwlaat
- R. Nieuwlaat, PhD, Associate Professor, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shahrzad Salmasi
- S. Salmasi, MSc, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Marieke Scholte-Voshaar
- M. Scholte-Voshaar, MSc, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands and OMERACT Patient Research Partner
| | - Jasvinder A Singh
- J.A. Singh, Professor, MD, Medicine Service, VA Medical Center, and Department of Medicine, School of Medicine, University of Alabama, and Division of Epidemiology, School of Public Health, University of Alabama, Birmingham, Alabama, USA
| | - Daniel Sumpton
- D. Sumpton, MBBS, FRACP, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, and Department of Rheumatology, Concord Hospital, Sydney, Australia
| | - Karine Toupin-April
- K. Toupin-April, PhD, Associate Scientist, Children's Hospital of Eastern Ontario Research Institute, and Assistant Professor, Department of Pediatrics and School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tugwell
- P. Tugwell, MD, Professor, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Bart van den Bemt
- B. van den Bemt, PhD, Assistant Professor, Department of Pharmacy, Radboud University Medical Centre, Nijmegen, and Department of Pharmacy, Sint Maartenskliniek, Ubbergen, the Netherlands
| | - Suzanne Verstappen
- S. Verstappen, PhD, Reader, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kathleen Tymms
- K. Tymms, MBBS, FRACP, Associate Professor, College of Health and Medicine, Australian National University, and Canberra Rheumatology, and Department of Rheumatology, Canberra Hospital, Canberra, Australia
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Mathijssen EGE, Vriezekolk JE, Popa CD, van den Bemt BJF. Shared decision making in routine clinical care of patients with rheumatoid arthritis: an assessment of audio-recorded consultations. Ann Rheum Dis 2019; 79:170-175. [DOI: 10.1136/annrheumdis-2019-216137] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/07/2019] [Accepted: 10/16/2019] [Indexed: 01/22/2023]
Abstract
ObjectivesAlthough shared decision making (SDM) is advocated in rheumatoid arthritis (RA) treatment, it is largely unclear when, how and to what extent SDM is applied in routine clinical care of patients with RA. This study aimed to investigate the level of SDM in RA treatment from an observer perspective and to assess associations between the level of SDM and characteristics of the clinician, patient and consultation.MethodsThe level of SDM was investigated by scoring audio-recordings of 168 routine consultations with unique patients with the observer patient involvement (OPTION) scale (scale 0–100, higher OPTION scores indicating higher levels of SDM). Associations between the level of SDM and characteristics of the clinician, patient and consultation were assessed using multilevel modelling. Statistical significance was set at p<0.05.ResultsThe mean OPTION score was 28.3 (SD=15.1). The multilevel model included four characteristics: clinician age, patient age, consultation duration and type of treatment decision. There were significant, positive associations between the level of SDM and the consultation duration (b=0.63, 95% CI 0.16 to 1.11), decision for stopping and/or starting medication (b=14.30, 95% CI 5.62 to 22.98), decision for adjusting medication doses (b=8.36, 95% CI 3.92 to 12.81) and decision for administering single dose glucocorticoids (b=15.03, 95% CI 9.12 to 20.93). Thus, a higher level of SDM was significantly associated with a longer consultation duration and the type of treatment decision. No other significant associations were found.ConclusionsOverall, the level of SDM in RA treatment leaves room for improvement. To foster SDM in routine clinical care, training programmes on patient-centred communication skills may be helpful.
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López-Medina C, Moltó A, Gérald F, Dubremetz M, Grange L, Thibaud G, Charles B, Lafarge D, Beauvais C, Gossec L, Dougados M. Assessment of the adherence to disease-modifying drugs in patients with chronic inflammatory rheumatic diseases: Results of a survey of 1594 patients. Joint Bone Spine 2019; 86:610-614. [DOI: 10.1016/j.jbspin.2019.01.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/30/2019] [Indexed: 12/22/2022]
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Juan Mas A, Castañeda S, Cantero Santamaría JI, Baquero JL, Del Toro Santos FJ. Adherence to synthetic disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis: Results of the OBSERVAR Study. REUMATOLOGIA CLINICA 2019; 15:264-270. [PMID: 29289700 DOI: 10.1016/j.reuma.2017.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Treatment compliance with disease-modifying antirheumatic drugs (DMARD) is essential to achieve the therapeutic goals in rheumatoid arthritis (RA). However, despite the need for good compliance, there is evidence that patients with RA frequently fail to use DMARD for the control of RA. Thus, the main objective of the OBSERVAR study is to evaluate the reasons for the lack of therapeutic adherence to synthetic DMARD in these patients. PATIENTS AND METHODS A Delphi process involving 18 randomly selected Spanish rheumatologists determined the level of agreement with 66 causes of noncompliance selected from the literature in relation to synthetic DMARD in RA. RESULTS The reasons for noncompliance were consistent in 75.7%, although 3 reasons (4.5%) were highly consistent: 1) not knowing what to do in the case of an adverse event with DMARD; 2) not having undergone adherence screening by health personnel for early detection of "noncompliant patients"; and 3) not having undergone interventions or strategies that improve adherence. CONCLUSION In order to improve adherence to RA treatment with synthetic DMARD, the patient should be adequately informed of each new treatment introduced, the patient's compliance profile should be incorporated into the clinical routine and the patient's motivation for therapeutic compliance be reinforced through the methods available to us.
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Affiliation(s)
- Antonio Juan Mas
- Servicio de Reumatología, Hospital Son Llàtzer , Palma de Mallorca, España
| | - Santos Castañeda
- Servicio de Reumatología, Hospital Universitario de La Princesa, Madrid, España.
| | - José I Cantero Santamaría
- Servicio de Urgencias de Atención Primaria, Servicio Cántabro de Salud, Santander, Cantabria, España
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van den Bemt BJF, Gettings L, Domańska B, Bruggraber R, Mountian I, Kristensen LE. A portfolio of biologic self-injection devices in rheumatology: how patient involvement in device design can improve treatment experience. Drug Deliv 2019; 26:384-392. [PMID: 30905213 PMCID: PMC6442222 DOI: 10.1080/10717544.2019.1587043] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Biologic drugs (e.g. anti-tumor necrosis factors) are effective treatments for multiple chronic inflammatory diseases including rheumatoid arthritis, axial spondyloarthritis, and psoriatic arthritis. Administration of biologic drugs is usually via subcutaneous self-injection, which provides many patient benefits compared to infusions including increased flexibility, reduced costs, and reduced caregiver burden. However, it is also associated with challenges such as needle phobia, patient treatment misconceptions and incorrect drug administration, and can be impacted by dexterity problems. Evidence suggests these problems, along with other drug administration challenges (e.g. patient forgetfulness, busy lifestyles, and polypharmacy), can reduce patient adherence to treatment. To combat these challenges, patient feedback has been used to develop a range of self-injection devices, including pre-filled syringes, pre-filled pens, and electronic injection devices. Providing different devices for drug administration gives patients the opportunity to choose a device that addresses the challenges they face as an individual. Research suggests involving patients in medical device development, providing patients with a choice of devices and enrolling individuals in patient support programs can empower patients to take control of their treatment journey. By providing a portfolio of self-injection devices, designed based on patient needs, patient experience will improve, potentially improving adherence and hence, long-term treatment outcomes.
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Affiliation(s)
- Bart J F van den Bemt
- a Department of Pharmacy , Sint Maartenskliniek , Ubbergen , The Netherlands.,b Department of Pharmacy , Radboud University Medical Centre , Nijmegen , The Netherlands
| | | | | | | | | | - Lars E Kristensen
- f The Parker Institute , Copenhagen University Hospital , Bispebjerg and Frederiksberg , Denmark
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25
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Wabe N, Lee A, Wechalekar M, McWilliams L, Proudman S, Wiese M. Factors associated with medication adherence in a longitudinal study of rheumatoid arthritis patients. Int J Clin Pract 2019; 73:e13375. [PMID: 31120169 DOI: 10.1111/ijcp.13375] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/08/2019] [Accepted: 05/20/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Identification of key determinants of medication adherence may assist with designing interventions to improve this important parameter. The aim of the study was to determine the rate and predictors of self-reported medication adherence in patients with rheumatoid arthritis (RA) over one-year follow-up. METHODS Socio-demographic, disease, therapy and patient-related factors were obtained from a longitudinal observational cohort of RA patients between May 2014 and June 2016. Medication adherence was measured using self-reported Compliance Questionnaire for Rheumatology (CQR) at baseline, 6 and 12 months. Mixed-effects modelling was used to investigate the relationship between adherence and potential predictors. RESULT Of 185 patients invited, 110 were included in the study. The median level of adherence was 71%-74% during the study period. Around 27%-30% of patients achieved > 80% adherence, while roughly one-fifth reported a CQR score within the lower quartile (CQR < 63%). After adjustment for potential confounders, increased age (β = 0.19, P = 0.010), higher self-efficacy (β = 0.89, P = 0.039) and higher medication necessity belief (β = 1.12, P < 0.0001) were associated with better self-reported adherence. CONCLUSION We found a moderate level of self-reported adherence over time and significant association with age, self-efficacy and medication necessity belief. The modifiable predictors of adherence found in this study can be used as a potential target for adherence-improving interventions.
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Affiliation(s)
- Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Anita Lee
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Mihir Wechalekar
- School of Medicine, Flinders University, Adelaide, SA, Australia
- Rheumatology Unit, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Leah McWilliams
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Michael Wiese
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
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Qualitative assessment of medication adherence in patients with rheumatic diseases on biologic therapy. Clin Rheumatol 2019; 38:2699-2707. [DOI: 10.1007/s10067-019-04609-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/11/2019] [Accepted: 05/15/2019] [Indexed: 12/26/2022]
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Oh YJ, Park B, Moon KW. Effect of Drug Adherence on Treatment Outcome in Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2019. [DOI: 10.4078/jrd.2019.26.4.264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yoon-Jeong Oh
- Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
- Office of Biostatistics, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Korea
| | - Ki Won Moon
- Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
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Use of Auto-Injector for Methotrexate Subcutaneous Self-Injections: High Satisfaction Level and Good Compliance in SELF-I Study, a Randomized, Open-Label, Parallel Group Study. Rheumatol Ther 2018; 6:47-60. [PMID: 30547379 PMCID: PMC6393262 DOI: 10.1007/s40744-018-0134-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction The objective of the study was to compare compliance and acceptability of a new auto-injector (AI) versus syringe for administration of methotrexate (MTX) in patients with rheumatoid arthritis (RA). Methods We conducted a randomized, open-label, parallel group study comparing AI to pre-filled syringe (PFS). Adult patients with RA (ACR/EULAR 2010) receiving MTX (orally or by injection) for at least 3 months were allocated to AI or PFS for 6 months and then were allocated to AI for 6 further months. Two co-primary endpoints were defined at M6: percentage of patients with compliance at least 80%; change in functional capacity assessed by Health Assessment Questionnaire (HAQ). Secondary endpoints included quality of life (RaQoL), RA activity (DAS28), and acceptability. Local safety at injection site was assessed at each visit. Results Two-hundred and sixty-five patients were randomized. The main analysis was conducted on per protocol set (99 AI and 98 PFS). Compliance was 96.2% in AI and 98.9% in PFS. Good complier rates were 89.9% and 94.9%, thus a difference of − 5.0% (− 18.9%; 8.9%). HAQ remained stable in both groups. No difference was found on RaQoL, change in RA activity, and safety profile. Autonomy, acceptability, and patient satisfaction were better with AI, and patients having had the experience of both AI and PFS preferred AI (p < 0.001). Conclusions Although this study did not demonstrate non-inferiority of AI versus PFS, compliance was excellent in the two groups, and AI, which was preferred by patients, is a valuable alternative to PFS for administration of MTX. Trial Registration ClinicalTrials.gov identifier, NCT02553018. Funding Nordic Pharma SAS.
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Nakagawa S, Nakaishi M, Hashimoto M, Ito H, Yamamoto W, Nakashima R, Tanaka M, Fujii T, Omura T, Imai S, Nakagawa T, Yonezawa A, Imai H, Mimori T, Matsubara K. Effect of medication adherence on disease activity among Japanese patients with rheumatoid arthritis. PLoS One 2018; 13:e0206943. [PMID: 30388179 PMCID: PMC6214559 DOI: 10.1371/journal.pone.0206943] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/21/2018] [Indexed: 11/19/2022] Open
Abstract
For the optimum efficacy of disease-modifying anti-rheumatic drugs (DMARDs), patients need to be adherent to their medication regimen. To clarify the effects of medication adherence on disease activity in Japanese patients with rheumatoid arthritis (RA), we conducted a cohort study in patients with various stages of RA. Patients were enrolled from the Kyoto University RA Management Alliance cohort, and followed up prospectively for 12 months. In this study, a total of 475 patients were analyzed and divided into 9 groups according to their medication adherence and the RA disease duration. The primary outcomes were based on the rate of a disease flare. The secondary outcomes were the changes in disease activity score using 28 joints (DAS28-ESR), simplified disease activity index (SDAI) and physical disability by health assessment questionnaire-disability index (HAQ). The changes in DAS28-ESR, HAQ, and the risk of disease flare in the highly adherent patients were significantly lower than those of the less adherent patients among the groups with RA ≤ 4.6 years but not those among the other groups. Taken together, this study identified a significant association between medication adherence and the disease flare during early-stage RA or short disease duration. These results emphasize the need to pay more attention to medication adherence in preventing the disease progression of RA.
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Affiliation(s)
- Shunsaku Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
- * E-mail:
| | - Mayumi Nakaishi
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Motomu Hashimoto
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Wataru Yamamoto
- Department of Health Information Management, Kurashiki Sweet Hospital, Kurashiki, Japan
| | - Ran Nakashima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masao Tanaka
- Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takao Fujii
- Department of Clinical Immunology and Rheumatology, Wakayama Medical University, Wakayama, Japan
| | - Tomohiro Omura
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Satoshi Imai
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Takayuki Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Atsushi Yonezawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Hirohisa Imai
- Graduate School of Medicine, Department of Medical and Pharmaceutical Community Healthcare, the University of Tokyo, Tokyo, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuo Matsubara
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
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Heidari P, Cross W, Crawford K. Do out-of-pocket costs affect medication adherence in adults with rheumatoid arthritis? A systematic review. Semin Arthritis Rheum 2018; 48:12-21. [DOI: 10.1016/j.semarthrit.2017.12.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/12/2017] [Accepted: 12/21/2017] [Indexed: 12/29/2022]
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Bonafede MMK, McMorrow D, Proudfoot C, Shinde S, Kuznik A, Chen CI. Treatment Persistence and Healthcare Costs Among Patients with Rheumatoid Arthritis After a Change in Targeted Therapy. AMERICAN HEALTH & DRUG BENEFITS 2018; 11:192-202. [PMID: 30464787 PMCID: PMC6207310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 04/12/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Targeted disease-modifying antirheumatic drug (DMARD) options for rheumatoid arthritis (RA) include tumor necrosis factor (TNF) inhibitors (adalimumab, certolizumab, etanercept, golimumab, infliximab) or alternative mechanisms of action (MOAs), such as a T-cell co-stimulation modulator (abatacept), Janus kinase inhibitor (tofacitinib), or interleukin-6 inhibitor (tocilizumab). OBJECTIVE To examine treatment persistence and healthcare costs in patients with RA who changed therapy by cycling therapy (ie, switching within the same drug class), or switching between, the TNF inhibitors and alternative MOA medication classes. METHODS We analyzed medical and pharmacy claims for commercially insured patients who cycled or switched between targeted DMARD agents between January 1, 2010, and September 30, 2014 (ie, the index date), to determine treatment patterns (ie, treatment switching, discontinuation, restarting after a gap ≥60 days, or persistence) and costs (plan- and patient-paid) for 1 year postindex. The cost per persistent patient was the total healthcare cost divided by the number of treatment-persistent patients. RESULTS The analysis included 6203 patients who cycled between TNF inhibitors, 2640 patients who switched from TNF inhibitors to alternative MOA agents, 699 patients who cycled between alternative MOA agents, and 687 patients who switched from alternative MOA agents to TNF inhibitors. The 1-year treatment persistence rates (with P values vs TNF inhibitor cyclers) were 45.2% for TNF inhibitor cyclers, 50.3% for TNF inhibitor-alternative MOA switchers (P <.001), 51.4% for alternative MOA agent cyclers (P = .002), and 46.1% for alternative MOA-TNF inhibitor switchers (P = .63). Compared with TNF inhibitor cyclers, the cost per persistent patient was lower for TNF inhibitor-alternative MOA switchers (-$16,853 RA-related; -$19,280 targeted DMARDs), alternative MOA agent cyclers (-$21,662 RA-related; -$25,153 targeted DMARDs), and alternative MOA-TNF inhibitor cyclers (-$7206 RA-related; -$7919 targeted DMARDs). CONCLUSION Among patients with RA, patients who switched from a TNF inhibitor to an alternative MOA agent and those who cycled between alternative MOA agents had significantly higher treatment persistence rates and a substantially lower cost per persistent patient than those who cycled between TNF inhibitors. These findings support the evaluation of switching medication classes for patients with RA when a targeted therapy fails.
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Affiliation(s)
- Machaon M K Bonafede
- Senior Director of Outcomes Research, Truven Health Analytics, an IBM Company, Cambridge, MA
| | | | | | - Shraddha Shinde
- Research Analyst, Health Economics and Outcomes Research, Sanofi
| | - Andreas Kuznik
- Senior Director, Health Economics and Outcomes Research, Regeneron Pharmaceuticals, Tarrytown, NY
| | - Chieh-I Chen
- Director, Health Economics and Outcomes Research, Regeneron Pharmaceuticals
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Kan HJ, Dyagilev K, Schulam P, Saria S, Kharrazi H, Bodycombe D, Molta CT, Curtis JR. Factors associated with physicians' prescriptions for rheumatoid arthritis drugs not filled by patients. Arthritis Res Ther 2018; 20:79. [PMID: 29720237 PMCID: PMC5932861 DOI: 10.1186/s13075-018-1580-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 03/27/2018] [Indexed: 12/22/2022] Open
Abstract
Background This study estimated the extent and predictors of primary nonadherence (i.e., prescriptions made by physicians but not initiated by patients) to methotrexate and to biologics or tofacitinib in rheumatoid arthritis (RA) patients who were newly prescribed these medications. Methods Using administrative claims linked with electronic health records (EHRs) from multiple healthcare provider organizations in the USA, RA patients who received a new prescription for methotrexate or biologics/tofacitinib were identified from EHRs. Claims data were used to ascertain filling or administration status. A logistic regression model for predicting primary nonadherence was developed and tested in training and test samples. Predictors were selected based on clinical judgment and LASSO logistic regression. Results A total of 36.8% of patients newly prescribed methotrexate failed to initiate methotrexate within 2 months; 40.6% of patients newly prescribed biologics/tofacitinib failed to initiate within 3 months. Factors associated with methotrexate primary nonadherence included age, race, region, body mass index, count of active drug ingredients, and certain previously diagnosed and treated conditions at baseline. Factors associated with biologics/tofacitinib primary nonadherence included age, insurance, and certain previously treated conditions at baseline. The area under the receiver operating characteristic curve of the logistic regression model estimated in the training sample and applied to the independent test sample was 0.86 and 0.78 for predicting primary nonadherence to methotrexate and to biologics/tofacitinib, respectively. Conclusions This study confirmed that failure to initiate new prescriptions for methotrexate and biologics/tofacitinib was common in RA patients. It is feasible to predict patients at high risk of primary nonadherence to methotrexate and to biologics/tofacitinib and to target such patients for early interventions to promote adherence.
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Affiliation(s)
- Hong J Kan
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Hampton House HH502, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | | | - Peter Schulam
- Computer Science Department, Johns Hopkins University, 3400 N Charles Sreett, Baltimore, MD, 21218, USA
| | - Suchi Saria
- Computer Science Department, Johns Hopkins University, 3400 N Charles Sreett, Baltimore, MD, 21218, USA
| | - Hadi Kharrazi
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Hampton House HH502, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - David Bodycombe
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Hampton House HH502, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Charles T Molta
- Main Line Rheumatology, Lankenau Medical Center, 100 Lancaster Avenue, Wynnewood, PA, 19096, USA
| | - Jeffrey R Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510 20th Street South, Birmingham, AL, 35294, USA
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Shaw Y, Metes ID, Michaud K, Donohue JM, Roberts MS, Levesque MC, Chang JC. Rheumatoid Arthritis Patients' Motivations for Accepting or Resisting Disease-Modifying Antirheumatic Drug Treatment Regimens. Arthritis Care Res (Hoboken) 2018; 70:533-541. [PMID: 28575542 DOI: 10.1002/acr.23301] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 06/01/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Patient refusal of and nonadherence to treatment with disease-modifying antirheumatic drugs (DMARDs) can adversely affect disease outcomes in rheumatoid arthritis (RA). This qualitative study describes how RA patients' feelings in response to experiences and information affected their decisions to accept (agree to adopt, initiate, and implement) or resist (refuse, avoid, and discontinue) DMARD treatment regimens. METHODS A total of 48 RA patients were interviewed about their experiences making decisions about DMARDs. The interviews were transcribed, coded, and analyzed for themes related to their internal motivations for accepting or resisting treatment regimens, using a narrative analysis approach. RESULTS In addition to feelings about the necessity and dangers of medications, patients' feelings towards their identity as an ill person, the act of taking medication, and the decision process itself were important drivers of patient's decisions. For patients' motivations to accept treatment regimens, 2 themes emerged: a desire to return to a normal life, and fear of future disability due to RA. For motivations to resist treatment regimens, 5 themes emerged: fear of medications, maintaining control over health, denial of sick identity, disappointment with treatment, and feeling overwhelmed by the cognitive burden of deciding. CONCLUSION Feelings in response to experiences and information played a major role in how patients weighed the benefits and costs of treatment options, suggesting that addressing patients' feelings may be important when rheumatologists counsel about therapeutic options. Further research is needed to learn how best to address patients' feelings throughout the treatment decision-making process.
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Affiliation(s)
- Yomei Shaw
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Ilinca D Metes
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and National Data Bank for Rheumatic Diseases, Wichita, Kansas
| | - Julie M Donohue
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Mark S Roberts
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | - Judy C Chang
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Kim D, Choi JY, Cho SK, Choi CB, Bang SY, Cha HS, Choe JY, Chung WT, Hong SJ, Kim TH, Kim TJ, Koh E, Lee HS, Lee J, Lee SS, Lee SW, Park SH, Shim SC, Yoo DH, Yoon BY, Bae SC, Sung YK. Prevalence and Associated Factors for Non-adherence in Patients with Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2018. [DOI: 10.4078/jrd.2018.25.1.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Dam Kim
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | | | - Soo-Kyung Cho
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | - Chan-Bum Choi
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | | | - Hoon-Suk Cha
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Yoon Choe
- Catholic University of Daegu School of Medicine, Daegu, Korea
| | | | | | - Tae-Hwan Kim
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Tae-Jong Kim
- Chonnam National University Hospital, Gwangju, Korea
| | - Eunmi Koh
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Jisoo Lee
- Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Shin-Seok Lee
- Chonnam National University Hospital, Gwangju, Korea
| | | | - Sung-Hoon Park
- Catholic University of Daegu School of Medicine, Daegu, Korea
| | | | - Dae-Hyun Yoo
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
| | - Yoon-Kyoung Sung
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, Korea
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Mathijssen EGE, Vriezekolk JE, Eijsbouts AMM, van den Hoogen FHJ, van den Bemt BJF. Support needs for medication use and the suitability of eHealth technologies to address these needs: a focus group study of older patients with rheumatoid arthritis. Patient Prefer Adherence 2018; 12:349-358. [PMID: 29563778 PMCID: PMC5846299 DOI: 10.2147/ppa.s152759] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The objectives of this study were to explore the needs of patients with rheumatoid arthritis (RA) regarding support for medication use and to gain insight into their perspective on the suitability of eHealth technologies to address these needs. METHODS Three focus groups were conducted with 28 patients with RA. Audio recordings made during the focus groups were transcribed verbatim. Two researchers independently performed an inductive, thematic analysis on the data (ie, the transcripts and field notes). RESULTS The following three themes that described support needs of patients with RA for medication use were identified in the data: 1) informational support; 2) practical support; and 3) emotional support. Informational support reflected the provision of information and facts, including advice, suggestions, and feedback from health care providers. Practical support included the reinforcement of practical skills as well as the provision of medication aids and pharmacy services. Emotional support reflected a trusted patient-health care provider relationship, characterized by good communication. Although potential advantages of eHealth technologies to address the patients' support needs were recognized, concerns over matters such as personal interaction with health care providers, privacy and data security, and the quality and reliability of online information were prevalent. CONCLUSION Patients with RA have informational, practical, and emotional support needs for medication use. Informational support seems to be most important. From the patients' perspective, eHealth technologies may have the potential to address these needs. However, these technologies are regarded as a complement to, rather than a replacement of, current practices.
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Affiliation(s)
- Elke GE Mathijssen
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
- Correspondence: Elke GE Mathijssen, Department of Rheumatology, Sint Maartenskliniek, PO Box 9011, 6500 GM, Nijmegen, the Netherlands, Tel +31 24 365 9185, Fax +31 24 365 9154, Email
| | | | - Agnes MM Eijsbouts
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Frank HJ van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Rheumatology, Radboud University Medical Centre, Nijmegen, the Netherlands
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Anghel LA, Farcaş AM, Oprean RN. Medication adherence and persistence in patients with autoimmune rheumatic diseases: a narrative review. Patient Prefer Adherence 2018; 12:1151-1166. [PMID: 30013327 PMCID: PMC6037147 DOI: 10.2147/ppa.s165101] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Several drugs are available for the treatment of autoimmune rheumatic diseases; however, their effectiveness may be negatively influenced by inappropriate adherence. Low adherence and persistence rates have a significant impact on patient quality of life and are associated with health-related expenses. PURPOSE To provide an up-to-date narrative review on treatment adherence and persistence rates, and discuss the factors that influence them, in patients with autoimmune rheumatic diseases. MATERIALS AND METHODS We searched the PubMed database for studies among patients with a diagnosis of rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), or psoriatic arthritis (PsA), published from January 2015 to February 2017. Only studies with a well-defined measurement of adherence/persistence and those that carried out an evaluation of the influencing factors were included. RESULTS Fifteen relevant studies that evaluated adherence and/or persistence were included. Adherence rates varied between 9.3% and 94%, and persistence rates between 23% and 80%. Most of the studies used one method to evaluate adherence or persistence (different questionnaire scores, proportion of days covered, and mean treatment duration). A high concordance was found between the adherence measurements of the Medication Event Monitoring System and Visual Analog Scale. Factors of economic, demographic, and clinical nature were only moderately linked to treatment adherence or persistence. However, patient-related factors - such as positive and increased beliefs in medication necessity, strong views of the chronic nature of the diseases, and increased knowledge of the disease - were related to better treatment adherence. CONCLUSION Owing to the heterogeneity of the study results, we consider that the use of more than one method to assess adherence/persistence should yield more comprehensive and accurate data about patient adherence behavior. Patient-related factors should be included and analyzed more often in adherence studies as the former may be modified to improve patient adherence.
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Affiliation(s)
- Laura-Alexandra Anghel
- Department of Analytical Chemistry and Instrumental Analysis, Faculty of Pharmacy, University of Medicine and Pharmacy "Iuliu Haţieganu", Cluj-Napoca, Romania,
| | - Andreea Maria Farcaş
- Drug Information Research Centre, University of Medicine and Pharmacy "Iuliu Haţieganu", Cluj-Napoca, Romania
| | - Radu Nicolae Oprean
- Department of Analytical Chemistry and Instrumental Analysis, Faculty of Pharmacy, University of Medicine and Pharmacy "Iuliu Haţieganu", Cluj-Napoca, Romania,
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Ahluwalia V, Rampakakis E, Movahedi M, Cesta A, Li X, Sampalis JS, Bombardier C. Predictors of patient decision to discontinue anti-rheumatic medication in patients with rheumatoid arthritis: results from the Ontario best practices research initiative. Clin Rheumatol 2017; 36:2421-2430. [PMID: 28879413 DOI: 10.1007/s10067-017-3805-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/16/2017] [Accepted: 08/25/2017] [Indexed: 01/28/2023]
Abstract
Despite the availability of treatment guidelines and effective treatments, real-world effectiveness remains suboptimal partly due to poor patient medication adherence. We evaluated a comprehensive set of sociodemographic, health insurance, and disease-related factors for association with patient decision to discontinue anti-rheumatic medications (ARMs) in a large observational RA cohort in Ontario, Canada. Patients from the Ontario Best Practices Research Initiative registry were included. The following predictors of ARM discontinuation were evaluated with cox-regression: patient age, gender, education, income, smoking, health insurance type/coverage, RA duration, erosion presence, RF positivity, DAS28-ESR, physician global, HAQ-DI, comorbidity number, ARM types, and physician characteristics (gender, academic position, urban vs. rural, distance from patient's residence). Patients (1762) were included with a mean (SD) age of 57.4 years (13.0). Approximately 80% were female, 29% had early (≤ 1 year) RA, and 70% were RF-positive. Mean (SD) baseline DAS28-ESR and HAQ-DI were 4.5 (1.5) and 1.2 (0.76), respectively. In multivariate analysis, married status (HR [95%CI] 0.73 [0.56-0.96]), RF positivity (0.73 [0.56-0.96]), and higher comorbidity number (0.92 [0.85-0.99]) were significant predictors of ARMs continuation while higher physician global (1.10 [1.04-1.15]), NSAID use (1.75 [1.29-2.38]), and number of ARMs (1.23 [1.07-1.40]) were associated with ARMs discontinuation. In a subset analysis assessing conventional or biologic DMARD discontinuation, higher HAQ-DI and biologic use over time were associated with lower hazard for discontinuation. Several sociodemographic, disease, and treatment parameters were identified as independent predictors of patient discontinuation of ARMs. These results should be considered when developing patient adherence support programs and in the choice of treatment regimens.
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Affiliation(s)
- Vandana Ahluwalia
- William Osler Health System, 314-40 Finchgate Blvd, Brampton, ON, L6T 3J1, Canada.
| | | | - Mohammad Movahedi
- JSS Medical Research, St-Laurent, QC, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Angela Cesta
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Xiuying Li
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - John S Sampalis
- JSS Medical Research, St-Laurent, QC, Canada.,McGill University, Montreal, QC, Canada
| | - Claire Bombardier
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of Rheumatology, Mount Sinai Hospital, Toronto, ON, Canada
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Abstract
BACKGROUND Nonadherence to treatment recommendations is associated with poorer outcomes in inflammatory bowel disease and may increase the cost of care. We examined the longitudinal relationship between nonadherence and health care costs and hypothesized that at least 3 distinct trajectories of nonadherence would be observed and that increasing nonadherence would account for significantly greater health care costs after controlling for disease activity. METHODS Ninety-nine patients aged 2 to 21 years with inflammatory bowel disease were recruited into this 2-year longitudinal study. Medication possession ratios were calculated from pharmacy refill data, disease activity ratings were obtained from medical charts, and hospital and physician charges associated with an International Classification of Diseases, Ninth Revision code for ulcerative colitis or Crohn's disease were obtained from the hospital's accounting database. RESULTS An average total cost effect size of d = 0.68 was observed between the increasing severity and stable low severity groups, but the confidence intervals overlap. Conversely, patients with increasing nonadherence demonstrated significantly higher health care costs than patients with stable ≤10%, stable 11% to 20%, or decreasing nonadherence. CONCLUSIONS Medication nonadherence is related to increased health care costs after controlling for disease severity. Patients with increasing nonadherence over time demonstrate more than a 3-fold increase in costs compared with adherent patients. In addition, patients whose adherence improves over time incur approximately the same costs as those who are consistently adherent. This suggests that, in addition to leveraging prevention efforts to keep patients from becoming more nonadherent as treatment continues, efforts aimed at modifying adherence behavior may result in significant cost savings over time.
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Wei W, Knapp K, Wang L, Chen CI, Craig GL, Ferguson K, Schwartzman S. Treatment Persistence and Clinical Outcomes of Tumor Necrosis Factor Inhibitor Cycling or Switching to a New Mechanism of Action Therapy: Real-world Observational Study of Rheumatoid Arthritis Patients in the United States with Prior Tumor Necrosis Factor Inhibitor Therapy. Adv Ther 2017; 34:1936-1952. [PMID: 28674959 PMCID: PMC5565674 DOI: 10.1007/s12325-017-0578-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Indexed: 12/19/2022]
Abstract
Introduction To examine treatment persistence and clinical outcomes associated with switching from a tumor necrosis factor inhibitor (TNFi) to a medication with a new mechanism of action (MOA) (abatacept, anakinra, rituximab, tocilizumab, or tofacitinib) versus cycling to another TNFi (adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab) among patients with rheumatoid arthritis. Methods This retrospective, longitudinal study included patients with rheumatoid arthritis in the JointMan® US clinical database who received a TNFi in April 2010 or later and either cycled to a TNFi or switched to a new MOA therapy by March 2015. Cox proportional hazards models were used for time to non-persistence (switching or discontinuing). An ordinary least squares regression model compared 1-year reduction from baseline for the Clinical Disease Activity Index (CDAI). Results There were 332 (54.2%) TNFi cyclers and 281 (45.8%) new MOA switchers. During a median follow-up of 29.9 months, treatment persistence was 36.7% overall. Compared with new MOA switchers, TNFi cyclers were 51% more likely to be non-persistent (adjusted hazard ratio, 1.511; 95% CI 1.196, 1.908), driven by a higher likelihood of switching again (adjusted hazard ratio, 2.016; 95% CI 1.428, 2.847). Clinical outcomes were evaluable for 239 (53.3%) TNFi cyclers and 209 (46.7%) new MOA switchers. One-year mean reduction in CDAI from baseline to end of follow-up was significantly higher for new MOA switchers than TNFi cyclers (−7.54 vs. −4.81; P = 0.037), but the difference was not statistically significant after adjustment for baseline CDAI (−6.39 vs. −5.83; P = 0.607). Conclusion In this study, TNFi cycling was common in clinical practice, but switching to a new MOA DMARD was associated with significantly better treatment persistence and a trend toward greater CDAI reduction that was not significant after adjustment for baseline disease activity. Funding Sanofi and Regeneron Pharmaceuticals.
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Affiliation(s)
- Wenhui Wei
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA.
| | | | - Li Wang
- STATinMED Research, Plano, TX, USA
| | - Chieh-I Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Wabe N, Wiese MD. Treating rheumatoid arthritis to target: physician and patient adherence issues in contemporary rheumatoid arthritis therapy. J Eval Clin Pract 2017; 23:486-493. [PMID: 27650675 DOI: 10.1111/jep.12620] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 07/10/2016] [Accepted: 07/11/2016] [Indexed: 11/29/2022]
Abstract
Development of the treat-to-target (T2T) strategy, the process whereby drug therapy is adjusted until the therapeutic goal is achieved, has revolutionized how rheumatoid arthritis (RA) patients are treated. With the advent of T2T, the management of RA is more effective than ever, with the possibility of remission and other favorable clinical and patient-reported outcomes. Effective implementation of a T2T strategy in routine clinical practice mainly depends on the long-term commitment of physician and patient to T2T treatment recommendations. However, as T2T is a complex process involving aggressive early management with several steps of therapy modifications requiring frequent close monitoring of disease activity and drug toxicities, it may be more liable to suboptimal adherence in real-life clinical practice. The aim of the review is to present key issues related to patient medication adherence and physician adherence to the current RA treatment recommendations and their importance in optimizing the outcome of treatment in RA treated according to T2T strategy.
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Affiliation(s)
- Nasir Wabe
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Michael D Wiese
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
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Ragab OM, Zayed HS, Abdelaleem EA, Girgis AE. Effect of early treatment with disease-modifying anti-rheumatic drugs and treatment adherence on disease outcome in rheumatoid arthritis patients. EGYPTIAN RHEUMATOLOGIST 2017. [DOI: 10.1016/j.ejr.2016.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Adherence to combination DMARD therapy and treatment outcomes in rheumatoid arthritis: a longitudinal study of new and existing DMARD users. Rheumatol Int 2017; 37:897-904. [PMID: 28160071 DOI: 10.1007/s00296-017-3655-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
Abstract
Medication adherence is believed to be a major contributor to treatment outcomes yet studies quantifying this relationship as rare in rheumatoid arthritis (RA). To determine the association of adherence to DMARD therapy with treatment outcomes among new and existing DMARD users over 2 years. Relevant clinical parameters were obtained from a longitudinal cohort of RA patients, most of who were treated with combination therapy. Patients were classified as adherent if the proportion of days covered for each DMARD was ≥80%. Outcome measures were the change in the disease activity score in 28 joints (DAS28), simplified disease activity index (SDAI), modified health assessment questionnaires (mHAQ) and proportion of patients who achieved response criteria. An inverse propensity-score weighting method was used to estimate the association of adherence with each outcome. Of 194 patients invited, a total of 111 patients (new = 45 and existing = 66 DMARD users) met study eligibility. DMARD-naive patients demonstrated relatively higher rates of adherence compared to existing users. After controlling for confounding variables, adherence was significantly associated with reduction in DAS28 (β = -1.5, 95% CI of β = - 2.17 to -0.83, p < 0.0001), SDAI (β = -9.44, 95% CI of β = -15.53 to -3.35, p = 0.002) and mHAQ (β = -0.269, 95% CI of β, -0.462 to -0.077, p = 0.017) over 2 years among new patients and adherent patients were more likely to achieve most response criteria compared to non-adherent patients. Such associations were not replicated among existing DMARD users. Adherence to combination DMARD therapy was associated with improvements in disease activity and functional outcomes in the first 2 years of therapy.
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Pasma A, Hazes JMW, Busschbach JJV, van der Laan WH, Appels C, de Man YA, Nieboer D, Timman R, van 't Spijker A. Psychosocial predictors of DMARD adherence in the first three months of treatment for early arthritis. PATIENT EDUCATION AND COUNSELING 2017; 100:126-132. [PMID: 27516438 DOI: 10.1016/j.pec.2016.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/20/2016] [Accepted: 07/13/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To induce disease remission, early arthritis patients should adhere to their disease-modifying antirheumatic drugs (DMARD) in the first months after diagnosis. It remains unknown why some patients are non-adherent. We aimed to identify patients at risk for non-adherence in the first 3 months of treatment. METHODS Adult DMARD-naive early arthritis patients starting synthetic DMARDs filled out items on potential adherence predictors at baseline. Adherence was measured continuously. Non-adherence was defined as not opening the electronically monitored pill bottle when it should have been. Items were reduced and clustered using principal component analysis. The most discriminating items were identified with latent trait models. We used a multivariable logistic regression model to find non-adherence predictors. RESULTS 301 patients agreed to participate. Adherence was high and declined over time. Principal component analysis led to 7 dimensions, while subsequent latent trait models analyses led to 15 dimensions. Two dimensions were associated with adherence, one dimension was associated with non-adherence. CONCLUSIONS Information seeking behavior and positive expectations about the course of the disease are associated with adherence. Patients who become passive because of pain are at risk for non-adherence. PRACTICE IMPLICATIONS Rheumatologists have cues to identify non-adherence, and may intervene on non-adherence through implementing shared decision making techniques.
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Affiliation(s)
- Annelieke Pasma
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Jan J V Busschbach
- Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | | | | | - Yaël A de Man
- Department of Rheumatology, Sint Antonius hospital, Nieuwegein, the Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Reinier Timman
- Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Adriaan van 't Spijker
- Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, the Netherlands
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Li L, Cui Y, Yin R, Chen S, Zhao Q, Chen H, Shen B. Medication adherence has an impact on disease activity in rheumatoid arthritis: a systematic review and meta-analysis. Patient Prefer Adherence 2017; 11:1343-1356. [PMID: 28831245 PMCID: PMC5553350 DOI: 10.2147/ppa.s140457] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Disease activity of rheumatoid arthritis (RA) patients was often measured by the 28-joint count disease activity score (DAS-28), which consists of 28 swollen and tender joint counts, patient's assessment of disease activity (visual analog scale [VAS]) and erythrocyte sedimentation rate. C-reactive protein was also used to measure disease activity in RA patients. The aim was to explore the impact of medication adherence on disease activity in patients with RA. METHODS A systematic search was performed in major electronic databases (PubMed, Web of Science, the Cochrane Library, CNKI, VIP and Wan fang) to identify studies reporting medication adherence and disease activity in RA patients. Results were expressed as mean difference (MD) and 95% CI. RESULTS A total of seven identified studies matched the inclusion criteria, reporting on a total of 1,963 adult RA patients in the analysis. The total score of DAS-28 was significantly lower in adherent patients than in nonadherent subjects (MD =-0.42, 95% CI [-0.80, -0.03], P=0.03). Similarly, a significant difference was observed between medication adherent and nonadherent groups in erythrocyte sedimentation rate (MD =-7.39, 95% CI [-11.69, -3.08], P<0.01) and tender joint count (MD =-1.29, 95% CI [-2.51, -0.06], P=0.04). Interestingly, the results of the meta-analysis showed no significant difference between medication adherent and nonadherent patients in swollen joint count (MD =-0.16, 95% CI [-2.13, 1.80], P=0.87), visual analog scale (MD =1.41, 95% CI [-3.68, 6.50], P=0.59) and C-reactive protein (MD =0.35, 95% CI [-0.64, 1.34], P=0.49). CONCLUSION The study suggests that RA patients with higher medication adherence tended to have lower disease activity.
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Affiliation(s)
- Lin Li
- Department of Nursing, The Second Affiliated Hospital of Nantong University, Nantong, China
- School of Nursing, Nantong University, Nantong, China
| | - Yafei Cui
- School of Nursing, Nantong University, Nantong, China
| | - Rulan Yin
- Department of Emergency ICU, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shengnan Chen
- School of Nursing, Nantong University, Nantong, China
| | - Qian Zhao
- School of Nursing, Nantong University, Nantong, China
| | - Haoyang Chen
- Department of Nursing, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Biyu Shen
- Department of Nursing, The Second Affiliated Hospital of Nantong University, Nantong, China
- Correspondence: Biyu Shen, Department of Nursing, The Second Affiliated Hospital of Nantong University, 6th Haier Lane Road, 2 26 001 Nantong, China, Tel +86 138 6293 7317, Email
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Curtis JR, Bykerk VP, Aassi M, Schiff M. Adherence and Persistence with Methotrexate in Rheumatoid Arthritis: A Systematic Review. J Rheumatol 2016; 43:1997-2009. [PMID: 27803341 DOI: 10.3899/jrheum.151212] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Medication adherence in patients with rheumatoid arthritis (RA) is typically suboptimal. Nonadherence has been associated with symptom worsening and increased disability. We systematically reviewed published clinical studies to evaluate methotrexate (MTX) adherence and persistence, factors associated with MTX adherence and persistence, and the effect of MTX nonadherence on clinical outcomes in RA. METHODS MEDLINE and Embase were systematically searched (inception to February 2016) using relevant keywords. Observational or interventional clinical studies in patients with RA that specifically reported adherence to or persistence with MTX were included. Data were extracted using a predesigned, standardized template that included study design, patient demographics, and relevant outcomes. Main outcomes were MTX adherence and persistence rates in patients with RA treated with MTX and factors associated with MTX adherence and persistence. RESULTS Of 365 references screened, 31 articles met inclusion criteria and another 10 were identified from searching reference lists. Estimates of MTX adherence varied from study to study because of heterogeneity in patient populations, duration of followup, definitions of adherence, and methods of assessment. Rates of MTX persistence ranged from 50% to 94% at 1 year and 25% to 79% at 5 years. No clear trends were identified in factors that influence MTX adherence and persistence. Two studies suggested that MTX adherence was associated with superior clinical outcomes. CONCLUSION MTX adherence and persistence are highly variable in patients with RA. Research is necessary to determine the effect of nonadherence on health outcomes and to identify independent predictors of nonadherence to inform evidence-based interventions.
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Affiliation(s)
- Jeffrey R Curtis
- From the Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Inflammatory Arthritis Center, Hospital for Special Surgery, New York, New York; Rheumatology Division, University of Colorado School of Medicine, Greenwood Village, Colorado, USA; Department of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; F. Hoffmann-La Roche Ltd., Basel, Switzerland. .,J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; V.P. Bykerk, MD, Inflammatory Arthritis Center, Hospital for Special Surgery, and Department of Rheumatology, Mount Sinai Hospital; M. Aassi, MD, F. Hoffmann-La Roche Ltd.; M. Schiff, MD, Rheumatology Division, University of Colorado School of Medicine.
| | - Vivian P Bykerk
- From the Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Inflammatory Arthritis Center, Hospital for Special Surgery, New York, New York; Rheumatology Division, University of Colorado School of Medicine, Greenwood Village, Colorado, USA; Department of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; F. Hoffmann-La Roche Ltd., Basel, Switzerland.,J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; V.P. Bykerk, MD, Inflammatory Arthritis Center, Hospital for Special Surgery, and Department of Rheumatology, Mount Sinai Hospital; M. Aassi, MD, F. Hoffmann-La Roche Ltd.; M. Schiff, MD, Rheumatology Division, University of Colorado School of Medicine
| | - Maher Aassi
- From the Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Inflammatory Arthritis Center, Hospital for Special Surgery, New York, New York; Rheumatology Division, University of Colorado School of Medicine, Greenwood Village, Colorado, USA; Department of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; F. Hoffmann-La Roche Ltd., Basel, Switzerland.,J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; V.P. Bykerk, MD, Inflammatory Arthritis Center, Hospital for Special Surgery, and Department of Rheumatology, Mount Sinai Hospital; M. Aassi, MD, F. Hoffmann-La Roche Ltd.; M. Schiff, MD, Rheumatology Division, University of Colorado School of Medicine
| | - Michael Schiff
- From the Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama; Inflammatory Arthritis Center, Hospital for Special Surgery, New York, New York; Rheumatology Division, University of Colorado School of Medicine, Greenwood Village, Colorado, USA; Department of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; F. Hoffmann-La Roche Ltd., Basel, Switzerland.,J.R. Curtis, MD, MS, MPH, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham; V.P. Bykerk, MD, Inflammatory Arthritis Center, Hospital for Special Surgery, and Department of Rheumatology, Mount Sinai Hospital; M. Aassi, MD, F. Hoffmann-La Roche Ltd.; M. Schiff, MD, Rheumatology Division, University of Colorado School of Medicine
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Abstract
BACKGROUND Capturing (non)-adherence to medical prescriptions in patients with inflammatory bowel disease (IBD) is challenging. We aimed to compare 3 different tools to measure self-assessed medication adherence of patients with IBD. METHODS Adult patients with Crohn's disease and ulcerative colitis were prospectively followed. IBD-specific medication use was collected by 3-monthly questionnaires. At 2.5 years of follow-up, medication adherence was assessed using 3 tools: (1) the 8-item Morisky Medication Adherence Scale (MMAS-8), (2) the single question how well patients take their daily medication using a Visual Analogue Scale (VAS), and (3) the Forget Medicine scale (FM), assessing how often patients forget their medication. Cross-sectional agreement among measures was visualized with scatterplots and quantified with Spearman's rank correlations. RESULTS In total, 913 patients with IBD were analyzed, 697 of whom received IBD-specific medication. High adherence on the MMAS-8 was consistent with high scores on the VAS and low scores on the FM. Disagreement between tools increased when patients were less adherent. A correlation of 0.44 was found between the MMAS-8 and VAS; -0.59 between the MMAS-8 and FM, and -0.55 between the VAS and FM (all P < 0.01). The VAS most optimally represented the quantitative variability of adherence, whereas the MMAS-8 and the FM might have resulted in overestimation or underestimation of adherence due to unequal differences in outcome possibilities. CONCLUSIONS In patients with IBD, a VAS seems the most appropriate tool for quantifying medication adherence in clinical practice. The MMAS-8 may be used additionally to provide insight in specific reasons for non-adherence.
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de Jong PHP, Hazes JM, Buisman LR, Barendregt PJ, van Zeben D, van der Lubbe PA, Gerards AH, de Jager MH, de Sonnaville PBJ, Grillet BA, Luime JJ, Weel AEAM. Best cost-effectiveness and worker productivity with initial triple DMARD therapy compared with methotrexate monotherapy in early rheumatoid arthritis: cost-utility analysis of the tREACH trial. Rheumatology (Oxford) 2016; 55:2138-2147. [PMID: 27581208 DOI: 10.1093/rheumatology/kew321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 07/28/2016] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To evaluate direct and indirect costs per quality adjusted life year (QALY) for different initial treatment strategies in very early RA. METHODS The 1-year data of the treatment in the Rotterdam Early Arthritis Cohort trial were used. Patients with a high probability (>70%) according to their likelihood of progressing to persistent arthritis, based on the prediction model of Visser, were randomized into one of following initial treatment strategies: (A) initial triple DMARD therapy (iTDT) with glucocorticoids (GCs) intramuscular (n = 91); (B) iTDT with an oral GC tapering scheme (n = 93); and (C) initial MTX monotherapy (iMM) with GCs similar to B (n = 97). Data on QALYs, measured with the Dutch EuroQol, and direct and indirect cost were used. Direct costs are costs of treatment and medical consumption, whereas indirect costs are costs due to loss of productivity. RESULTS Average QALYs (sd) for A, B and C were, respectively, 0.75 (0.12), 0.75 (0.10) and 0.73 (0.13) for Dutch EuroQol. Highest total costs per QALY (sd) were, respectively, €12748 (€18767), €10 380 (€15 608) and €17 408 (€21 828) for strategy A, B and C (P = 0.012, B vs C). Direct as well as indirect costs were higher with iMM (strategy C) compared with iTDT (strategy B). Higher direct costs were due to ∼40% more biologic usage over time. Higher indirect costs, on the other hand, were caused by more long-term sickness and reduction in contract hours. iTDT was >95% cost-effective across all willingness-to-pay thresholds compared with iMM. CONCLUSION iTDT was more cost-effective and had better worker productivity compared with iMM.
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Affiliation(s)
| | | | | | | | - Derkjen van Zeben
- Department of Rheumatology, Sint Francicus Gasthuis Hospital, Rotterdam
| | | | | | - Mike H de Jager
- Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht
| | | | - Bernard A Grillet
- Department of Rheumatology, Zorgsaam Hospital, Terneuzen, the Netherlands
| | | | - Angelique E A M Weel
- Department of Rheumatology, Erasmus Medical Center.,Department of Rheumatology, Maasstad Hospital
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Machado MADÁ, Bernatsky S, Bessette L, Nedjar H, Rahme E. Hospitalization for musculoskeletal disorders in rheumatoid arthritis patients: a population-based study. BMC Musculoskelet Disord 2016; 17:298. [PMID: 27431503 PMCID: PMC4950266 DOI: 10.1186/s12891-016-1142-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/17/2016] [Indexed: 12/01/2022] Open
Abstract
Background Rheumatoid arthritis (RA) patients failing disease modifying antirheumatic drugs (DMARDs) may undergo anti-Tumor Necrosis Factor (anti-TNF) therapy. Using the Quebec health services administrative databases, we examined the rates of musculoskeletal (MSD)-related hospitalizations among RA patients receiving anti-TNF, DMARDs, and neither of those therapies (non-users). Methods Matched cohort analyses were performed separately in 2002–2006 and 2007–2011. In each cohort, DMARD and non-user groups were formed to 3-1 match the anti-TNF users on age, sex, date of RA diagnosis, high-dimensional propensity score and date of the first anti-TNF dispensation (index-date). Non-users did not use DMARDs or anti-TNF drugs during the year before the index-date and in the 90 days post, but used at least one of these medications in the study period. Results During 2002–2006, 557 anti-TNF users were matched to 1144 DMARD users and to 656 non-users, compared to 690, 1651, and 532 patients, respectively during 2007–2011. The crude rates of MSD-related hospitalizations in the anti-TNF, DMARD and non-users groups were respectively: 8.2/100, 6.4/100 and 10.5/100 patient-years in 2002–2006, and 6.9/100, 4.8/100, and 8.6/100 patient-years in 2007–2011. In multivariable Cox regression models, the hazard ratios of MSD-related hospitalizations (95 % confidence interval) were: 0.95 (0.60; 1.50) for anti-TNF and 0.69 (0.46; 1.02) for DMARD users, versus non-users in 2002–06, and 0.65 (0.37; 1.14) and 0.40 (0.24; 0.66), respectively in 2007–2011. Conclusion The MSD-related hospitalization risk was lower in RA patients using DMARD therapy and similar in those using anti-TNF therapy with or without DMARDs as compared to those not using either of these therapies during the study period.
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Affiliation(s)
- Marina Amaral de Ávila Machado
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,College of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Sasha Bernatsky
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Ave West, V building, Montreal, QC, H3A 1A1, Canada
| | - Louis Bessette
- Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, QC, Canada
| | - Hacene Nedjar
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Elham Rahme
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada. .,Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Ave West, V building, Montreal, QC, H3A 1A1, Canada.
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49
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Pasma A, den Boer E, van 't Spijker A, Timman R, van den Bemt B, Busschbach JJV, Hazes JMW. Nonadherence to disease modifying antirheumatic drugs in the first year after diagnosis: comparing three adherence measures in early arthritis patients. Rheumatology (Oxford) 2016; 55:1812-9. [PMID: 27354686 DOI: 10.1093/rheumatology/kew247] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare three measurement methods for non-adherence to DMARDs in early arthritis patients: the Compliance Questionnaire Rheumatology (CQR), the intracellular uptake of MTX in the form of MTX-polyglutamates (MTX-PGs) and electronic measurement with Medication Event Monitoring Systems (MEMS). METHODS DMARD naïve early arthritis patients were included in an ongoing cohort study. MEMS were used to measure adherence continuously, while every 3 months MTX-PGs were collected together with the CQR. The associations between the measures were estimated with Spearman rank correlations. Sensitivity and specificity of the CQR against a MEMS cut-off was compared at 3, 6, 9 and 12 months. The same applied to MTX-PGs against a MEMS cut-off and MTX-PGs against a CQR cut-off. For the association between MEMS, the CQR and MTX-PGs, a multilevel linear regression model was performed with age, gender, weeks of treatment and MTX dosage as covariates. RESULTS We included 206 patients. Non-adherence measured with MEMS varied over time and between DMARDs. The CQR score was not associated with MEMS non-adherence at 3, 9 and 12 months. At 9 months, MTX-PGs was associated with MEMS non-adherence, as well as with the CQR. All correlations were below 0.30. CONCLUSION Associations between the three measures are weak. Explanations are individual differences in the uptake of MTX, and little variance in adherence between patients. Moreover, the measurement domains differ: perceptions (CQR), behaviour (MEMS) and pharmacokinetics (MTX).
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Affiliation(s)
| | | | - Adriaan van 't Spijker
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, University Medical Center Rotterdam
| | - Reininer Timman
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, University Medical Center Rotterdam
| | - Bart van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Jan J V Busschbach
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, University Medical Center Rotterdam
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Zhang W, Luo X, Zhang F, Zhu Y, Yang B, Hou M, Xu Z, Yu C, Chen Y, Chen L, Ji M. SjTat-TPI facilitates adaptive T-cell responses and reduces hepatic pathology during Schistosoma japonicum infection in BALB/c mice. Parasit Vectors 2015; 8:664. [PMID: 26714844 PMCID: PMC4696208 DOI: 10.1186/s13071-015-1275-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/18/2015] [Indexed: 12/18/2022] Open
Abstract
Background Schistosomiasis is a kind of parasitic zoonoses which causes serious damage to public health and social development. China is one of the countries most affected by Schistosoma japonicum and an effective vaccine is still needed. In this study, we adopted Tat-mediated protein transduction technology to investigate the impact of different antigen presented approaches on host’s immune response and the potential protection against Schistosoma japonicum infection. Results We successfully constructed the recombinant S. japonicum triosephosphate isomerase, Tat-TPI, as a vaccine candidate. Whether injected with Tat-TPI in foot pad or vaccinated with Tat-TPI in the back subcutaneously for three times, the draining popliteal lymph nodes and spleen both developed a stronger CD8+T response (Tc1) in mice. Not only that, but it also helped CD4+T cells to produce more IFN-γ than TPI immunisation. In addition, it could boost IgG production, especially IgG1 subclass. Most importantly, Tat-TPI immunisation led to the significant smaller area of a single egg granuloma in the livers as compared with TPI-vaccinated or control groups. However, the anti-infection efficiency induced by Tat-TPI was still restricted. Conclusion This study indicated that immunisation with Tat-fused TPI could contribute to enhance CD4+T-cell response and decrease hepatic egg granulomatous area after S. japonicum infection though it did not achieve our expected protection against Schistosoma japonicum infection. The optimal vaccine strategy warrants further research.
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Affiliation(s)
- Wenyue Zhang
- Department of Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, 210029, China.
| | - Xiaofeng Luo
- Department of Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, 210029, China.
| | - Fan Zhang
- Department of Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, 210029, China.
| | - Yuxiao Zhu
- Department of Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, 210029, China.
| | - Bingya Yang
- Department of Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, 210029, China. .,Jiangsu Province Key Laboratory of Modern Pathogen Biology, Nanjing, Jiangsu, 210029, China.
| | - Min Hou
- Department of Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, 210029, China.
| | - Zhipeng Xu
- Department of Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, 210029, China. .,Jiangsu Province Key Laboratory of Modern Pathogen Biology, Nanjing, Jiangsu, 210029, China.
| | - Chuanxin Yu
- Jiangsu Institute of Parasitic Diseases, Wuxi, Jiangsu, 214064, China.
| | - Yingying Chen
- Department of Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, 210029, China.
| | - Lin Chen
- Department of Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, 210029, China. .,Jiangsu Province Key Laboratory of Modern Pathogen Biology, Nanjing, Jiangsu, 210029, China.
| | - Minjun Ji
- Department of Pathogen Biology, Nanjing Medical University, Nanjing, Jiangsu, 210029, China. .,Jiangsu Province Key Laboratory of Modern Pathogen Biology, Nanjing, Jiangsu, 210029, China.
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