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Santiago-Garcia AP, Gamez-Nava JI, Avalos-Salgado FA, Cerpa-Cruz S, Amaya-Cabrera EL, Gutierrez-Ureña S, Nava-Valdivia CA, Gonzalez-Vazquez S, Arevalo-Simental DE, Gomez-Camarena JJ, Ponce-Guarneros JM, Rodriguez-Jimenez NA, Saldaña-Cruz AM, Cardona-Muñoz EG, Gonzalez-Lopez L. Complementary Therapies and Their Association with Problems in Therapeutic Adherence to Conventional Synthetic DMARDs in Rheumatoid Arthritis: A Cross-Sectional Study. Healthcare (Basel) 2023; 12:49. [PMID: 38200955 PMCID: PMC10779410 DOI: 10.3390/healthcare12010049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
The use of complementary therapies is highly prevalent among patients with rheumatoid arthritis (RA). Nevertheless, the use of complementary medicine could involve problems in the following of scientifically accepted treatments. To date, there is limited information regarding the association of nonconventional therapies with problems regarding compliance with the treatment. Therefore, the objective of this study was to identify whether the utilization of complementary therapies is associated with a high risk of problems regarding therapeutic adherence to conventional synthetic disease-modifying anti-rheumatic drugs (cs-DMARDs) in RA patients. A survey was performed with RA patients in an outpatient rheumatology clinic in a university hospital; the use of complementary therapies, as well as their type, was identified. To assess problems with therapeutic adherence, we used the four-item Morisky-Green scale. A comprehensive assessment of clinical and therapeutic characteristics was performed. Univariable and multivariable models were performed to identify the risk of problems with therapeutic adherence in users of complementary therapies. In total, 250 RA patients were included; 92% used complementary therapies. Of them, the most frequently used were herbal medicine (65%), homeopathy (64%), and cannabis and its derivatives (51%). In the univariable logistic regression analysis, the factors associated with problems in the therapeutic adherence to cs-DMARDs were age (p = 0.019), the presence of other comorbidities (p = 0.047), and the use of complementary therapies (p = 0.042). After controlling for potential confounders, the use of complementary therapies increased the risk of problems with therapeutic adherence to cs-DMARDs (adjusted OR = 2.84, 95% CI = 1.06-7.63, p = 0.037). We concluded that the use of complementary therapies increases the risk of problems with therapeutic adherence. Therefore, for physicians and healthcare professionals, the early identification of the use of nonconventional therapies in their RA patients is required, followed by a directed discussion with their patients about the risks and benefits to which they could be exposed to complementary therapies.
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Affiliation(s)
- Aline Priscilla Santiago-Garcia
- Programa de Doctorado en Farmacologia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (A.P.S.-G.); (J.I.G.-N.); (F.A.A.-S.); (S.G.-U.); (D.E.A.-S.); (J.J.G.-C.); (J.M.P.-G.); (N.A.R.-J.); (A.M.S.-C.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - Jorge Ivan Gamez-Nava
- Programa de Doctorado en Farmacologia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (A.P.S.-G.); (J.I.G.-N.); (F.A.A.-S.); (S.G.-U.); (D.E.A.-S.); (J.J.G.-C.); (J.M.P.-G.); (N.A.R.-J.); (A.M.S.-C.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
- Programa de Maestria en Salud Publica, Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Felipe Alexis Avalos-Salgado
- Programa de Doctorado en Farmacologia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (A.P.S.-G.); (J.I.G.-N.); (F.A.A.-S.); (S.G.-U.); (D.E.A.-S.); (J.J.G.-C.); (J.M.P.-G.); (N.A.R.-J.); (A.M.S.-C.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - Sergio Cerpa-Cruz
- Departamento de Reumatología, Hospital Civil Fray Antonio Alcalde, Guadalajara 45019, Mexico; (S.C.-C.); (E.L.A.-C.)
| | - Edna Lizeth Amaya-Cabrera
- Departamento de Reumatología, Hospital Civil Fray Antonio Alcalde, Guadalajara 45019, Mexico; (S.C.-C.); (E.L.A.-C.)
| | - Sergio Gutierrez-Ureña
- Programa de Doctorado en Farmacologia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (A.P.S.-G.); (J.I.G.-N.); (F.A.A.-S.); (S.G.-U.); (D.E.A.-S.); (J.J.G.-C.); (J.M.P.-G.); (N.A.R.-J.); (A.M.S.-C.)
| | - Cesar Arturo Nava-Valdivia
- Departamento de Microbiología y Patología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - Sergio Gonzalez-Vazquez
- Hospital General Regional 110 Instituto Mexicano del Seguro Social, Guadalajara 44716, Mexico;
| | - Diana Esperanza Arevalo-Simental
- Programa de Doctorado en Farmacologia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (A.P.S.-G.); (J.I.G.-N.); (F.A.A.-S.); (S.G.-U.); (D.E.A.-S.); (J.J.G.-C.); (J.M.P.-G.); (N.A.R.-J.); (A.M.S.-C.)
| | - Jose Jorge Gomez-Camarena
- Programa de Doctorado en Farmacologia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (A.P.S.-G.); (J.I.G.-N.); (F.A.A.-S.); (S.G.-U.); (D.E.A.-S.); (J.J.G.-C.); (J.M.P.-G.); (N.A.R.-J.); (A.M.S.-C.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - Juan Manuel Ponce-Guarneros
- Programa de Doctorado en Farmacologia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (A.P.S.-G.); (J.I.G.-N.); (F.A.A.-S.); (S.G.-U.); (D.E.A.-S.); (J.J.G.-C.); (J.M.P.-G.); (N.A.R.-J.); (A.M.S.-C.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Norma Alejandra Rodriguez-Jimenez
- Programa de Doctorado en Farmacologia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (A.P.S.-G.); (J.I.G.-N.); (F.A.A.-S.); (S.G.-U.); (D.E.A.-S.); (J.J.G.-C.); (J.M.P.-G.); (N.A.R.-J.); (A.M.S.-C.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Ana Miriam Saldaña-Cruz
- Programa de Doctorado en Farmacologia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (A.P.S.-G.); (J.I.G.-N.); (F.A.A.-S.); (S.G.-U.); (D.E.A.-S.); (J.J.G.-C.); (J.M.P.-G.); (N.A.R.-J.); (A.M.S.-C.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Ernesto German Cardona-Muñoz
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Laura Gonzalez-Lopez
- Programa de Doctorado en Farmacologia, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico; (A.P.S.-G.); (J.I.G.-N.); (F.A.A.-S.); (S.G.-U.); (D.E.A.-S.); (J.J.G.-C.); (J.M.P.-G.); (N.A.R.-J.); (A.M.S.-C.)
- Research Group for Factors Related to Therapeutic Outcomes in Autoimmune Diseases, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
- Programa de Maestria en Salud Publica, Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico
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Shah MH, Honnekeri AS, Samat DA, Shah P, Nayak UV, Kini SG. Digging Deep: Medication Adherence in Chronic Diseases and Its Association With Patient Satisfaction and Stress in an Indian Metropolis. Cureus 2023; 15:e46493. [PMID: 37800166 PMCID: PMC10550356 DOI: 10.7759/cureus.46493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Medication adherence is a critical aspect of managing chronic diseases. Poor medication adherence leads to therapeutic failures and increased health costs, and puts patients at potentially life-threatening risks.The impact is felt drastically by patients suffering from chronic diseases. Patient satisfaction is known to be strongly associated with medication adherence. Psychosocial factors such as depression have been proven to negatively affect medication adherence; however, to our best knowledge, the association of stress with adherence remains largely unexplored. Objectives The aim of this study is to explore or assess the relationship between medication adherence, patient satisfaction, and stress levels. Methods A cross-sectional observational study was conducted within an Indian metropolitan city (Mumbai) among adults diagnosed and treated for at least one chronic disease with a medication regimen spanning over three months. An online questionnaire was designed, incorporating validated scales such as the Adherence to Refills and Medications Scale, Short Assessment of Patient Satisfaction, and Perceived Stress Scale. Results In the study, 23.7% of participants (n=300) showed adherence to their prescribed treatment regimen. Adherence exhibited a positive association with age (p=0.009) and educational attainment (p=0.031). Additionally, a significant gender difference emerged, with males (28%) displaying higher adherence rates compared to females (16.7%) (p=0.036). Furthermore, participants reporting lower stress levels exhibited higher adherence (39.5%), while those experiencing moderate-to-high stress levels displayed reduced adherence rates (17-18.8%) (p<0.05). Patient satisfaction was also linked to adherence, as satisfied individuals demonstrated higher adherence levels (29.1%) in contrast to dissatisfied counterparts (15.7%) (p=0.011). Conclusion Level of medication adherence is much lower in India as compared to other developed nations. Various demographic factors such as age, sex, and education status influence adherence. Physician counselling plays an important role in adherence, and satisfied patients are far more adherent. Furthermore, a significant negative association was found between stress and adherence.
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Affiliation(s)
- Medha H Shah
- Pharmacology and Therapeutics, K. J. (Karamshi Jethabhai) Somaiya Medical College, Mumbai, IND
| | - Amalesh S Honnekeri
- Pharmacology and Therapeutics, K. J. (Karamshi Jethabhai) Somaiya Medical College, Mumbai, IND
| | - Divya A Samat
- Pharmacology and Therapeutics, K. J. (Karamshi Jethabhai) Somaiya Medical College, Mumbai, IND
| | - Priyanshi Shah
- Internal Medicine, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, IND
| | - Usha V Nayak
- Pharmacology and Therapeutics, K. J. (Karamshi Jethabhai) Somaiya Medical College, Mumbai, IND
| | - Shobha G Kini
- Physiology, K. J. (Karamshi Jethabhai) Somaiya Medical College, Mumbai, IND
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Albuquerque ES, Pinto LDS, Neto VL, Fragoso TS. Medication adherence in systemic lupus erythematosus during Brazilian COVID-19 pandemic. Lupus 2022; 31:221-227. [PMID: 35077262 PMCID: PMC8792910 DOI: 10.1177/09612033221074177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with chronic diseases are potential candidates for inadequate follow-up of drug therapy, tending to incur damage to the intended results. This deserves greater attention in the pandemic period, as they are in the considered risk group. METHODS We aim to assess Treatment Adherence Measure and analyze associations with characteristics related to the patient, treatment, disease, health professionals and service, and sociodemographic issues in patients with Systemic Lupus Erythematosus (SLE). W conducted a cross-sectional study with a sample of 116 participants, whose data were collected through individual interviews and review of medical records, during the first months of the COVID-19 pandemic in Brazil. Adherence was measured using the Treatment Adherence Measure, and associations were evidenced through described and inferential statistics. RESULTS The percentage of adherent patients was 55.2%. An association was found between MTA (Medication Treatment Adherence) and physical exercise practice (p = 0.032), and difficulties with treatment (p = 0.002). Conclusion: Participants who did not practice physical exercise were 3.71 times more likely to not adhere to the treatment. Individuals who identified difficulties in the treatment were 3.43 times more likely to not adhere to the treatment; we believe that the pandemic may have influenced this result. More targeted studies are needed to measure the impact on MTA in these patients.
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Affiliation(s)
- Emmanuele S Albuquerque
- Emmanuele S Albuquerque, Faculty of Medicine, Federal University of Alagoas, Av. Lourival Melo Mota, s/n - Tabuleiro do Martins, Maceio 57072-970, Brazil.
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Selected psychological factors and medication adherence in patients with rheumatoid arthritis. Reumatologia 2021; 59:90-97. [PMID: 33976462 PMCID: PMC8103406 DOI: 10.5114/reum.2021.105433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/06/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives The aim of the study was to determine the relationship between medication adherence (MA) and selected psychological factors in a group of patients with rheumatoid arthritis (RA). Material and methods The cross-sectional study was conducted in four rheumatology outpatient clinics in Silesia, Poland. The tests used were the Medication Adherence Questionnaire (MAQ), the Multidimensional Health Locus of Control Scale (MHLC), the Coping Inventory for Stressful Situations (CISS), and the Mindful Attention Awareness Scale (MAAS). The analysis involved 106 adult patients diagnosed with RA at least 6 months before, who were prescribed medication, with disease at any stage and with stable comorbidities. Software was used to perform analyses of frequency, basic descriptive statistics, including the Kolmogorov-Smirnov test, Student’s t-test for independent samples, intergroup univariate variance, Pearson’s r correlation coefficient, Spearman’s rank correlation ρ coefficient, Fisher’s exact test and stepwise linear regression. Results Powerful Others Health Locus of Control (PHLC), Internal Health Locus of Control (IHLC) and age of the subjects, F(3, 102) = 8.05; p < 0.001 explained 16.8% of the variation in the adherence level for the entire group. In the group of women PHLC and IHLC, F(2, 80) = 10.04; p < 0.001 were included in the model, which explained 18.1% of variation in MA. PHLC was the most significant factor in the group of women (β = 0.55; p < 0.001) and in the entire group (β = 0.48; p < 0.001). In the group of men, Social Diversion Style (SDS), F(1, 21) = 5.81; p = 0.02 was included in the model, which explained 17.9% of the variation in the MA level. Conclusions The study identified some psychological predictors of adherence, which explained 16.8% of the variability. Factors increasing the likelihood of medication adherence in patients with rheumatoid arthritis include a strong belief in the power of others, low level of internal health locus of control, and advanced age.
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Gallotti FC, Serafini MR, Thomazzi SM. Scenario of the Treatment of Arthritis with Natural Products. ACTA ACUST UNITED AC 2021; 14:95-105. [DOI: 10.2174/1872213x14666200228103001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/19/2020] [Accepted: 02/23/2020] [Indexed: 11/22/2022]
Abstract
Background:
Conventional treatments of arthritis use toxic and poorly tolerated drugs.
Therefore, natural products are an alternative because they are important sources of bioactive substances
with therapeutic potential.
Objective:
To perform synthesis of patent applications associated with the use of natural products
in the technological development of the invention for use in treating arthritis.
Methods:
The search for patents was conducted using the following databases of World Intellectual
Property Organization (WIPO), European Patent Office (EPO, Espacenet), United States Patents
and Trademark Office (USPTO) and National Institute of Intellectual Property (INPI) using as keywords
- arthritis, treatment and the International Patent Classification (IPC) A61K36 / 00.
Results:
A total of 617 patents related to the subject were registered in the period available in patents
databases during the study period from the years 2005 to 2017, of which 44 were analyzed
based on the established inclusion criteria. The most important countries for protecting these inventions
were China, followed by the United States of America, the Republic of Korea and Japan. As
for the typology of depositors, that were identified by Educational Institutions and Public Institutes
of Research (IEIPP) and Companies and Private Research Institutes (EIPP).
Conclusion:
The analysis of patents made it possible to characterize the natural products used in
the treatment of arthritis, with emphasis on botanical extracts (71%), as a single component, as
well as in association with other botanical extracts, isolated compounds and minerals.
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Affiliation(s)
| | | | - Sara M. Thomazzi
- Department of Physiology, University of Sergipe, Sao Cristovao, Brazil
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Naqvi AA, Hassali MA, Rizvi M, Zehra A, Nisa ZU, Islam MA, Iqbal MS, Farooqui M, Imam MT, Hossain MA, Khan I, Iqbal MZ, Ali M, Haseeb A. Validation of the General Medication Adherence Scale in Pakistani Patients With Rheumatoid Arthritis. Front Pharmacol 2020; 11:1039. [PMID: 32765264 PMCID: PMC7379482 DOI: 10.3389/fphar.2020.01039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim was to validate the Urdu version of General Medication Adherence Scale (GMAS) in patients with rheumatoid arthritis disease. METHODS A 2-month (March-April 2019) cross-sectional study was conducted in randomly selected out-patients with rheumatoid arthritis. The sample size was calculated using item-subject ratio of 1:20. The scale was evaluated for factorial, concrete, concurrent, and known group validities. Concrete validity was established by correlating scores of EQ-5D quality of life scale and GMAS adherence score. Concurrent validity was established by correlating the GMAS adherence score with pill count. Analyses for sensitivity were also conducted. Cut-off value was determined through receiver operator curve (ROC), and test-retest method was used to analyze internal consistency and reliability. Data were analyzed through IBM SPSS, IBM AMOS, and MedCalc software. The Urdu version of EQ-5D quality of life questionnaire was used with permission from developers (#ID20884). The study was approved by an ethics committee (#NOV:15). RESULTS A total of 351 responses were analyzed. The response rate was 98%. Reliability was in acceptable range, i.e., Cronbach α = 0.797. Factorial validity was established by calculation of satisfactory fit indices. Correlation coefficients for concrete and concurrent validities were ρ = 0.687, p < 0.01 and ρ = 0.779, p < 0.01, respectively. Known group validity was established as significant association of adherence score with insurance and illness duration (p < 0.05) that were reported. Sensitivity of the scale was 94%. Most patients had high adherence (N = 159, 45.3%). CONCLUSION The Urdu version of GMAS demonstrated adequate internal consistency and was validated. These results indicate that it is an appropriate tool to measure medication adherence in Pakistani patients with rheumatoid arthritis.
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Affiliation(s)
- Atta Abbas Naqvi
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mehwish Rizvi
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Ale Zehra
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Zeb-un- Nisa
- Faculty of Pharmacy, Ziauddin University, Karachi, Pakistan
| | - Md. Ashraful Islam
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Maryam Farooqui
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Mohammad Tarique Imam
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia
| | - Mohammad Akbar Hossain
- Department of Pharmacology and Toxicology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Irfanullah Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Muhammad Zahid Iqbal
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, AIMST University, Bedong, Malaysia
| | - Majid Ali
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia
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Mahran SA, Khedr TM, Mohammed EM, El-Hakeim EMH. Medication adherence to disease-modifying anti-rheumatic drugs among patients with rheumatoid arthritis at Assiut University Hospital, Egypt. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2020. [DOI: 10.1186/s43166-020-00005-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
Background
Rheumatoid arthritis is a chronic disabling autoimmune disease with predilection to synovial joints and many extraarticular manifestations. Disease-modifying anti-rheumatic drugs are the cornerstone and initial therapy in rheumatoid arthritis. Although medication adherence is crucial for successful therapy, non-adherence is a substantial problem in some. This study aimed to determine the adherence rate of treatment with disease-modifying anti-rheumatic drugs among patients with rheumatoid arthritis in an Egyptian university hospital. In this study, seventy-three adult rheumatoid arthritis patients who are on disease-modifying anti-rheumatic drugs treatment for at least 6 months were included in this study. After full history and clinical examination, assessment of the adherence rate to disease-modifying anti-rheumatic drugs was done using the Clinician Rating Scale. Measuring the quality of life using the Health Assessment Questionnaire Disability Index and screening for depression and anxiety using the Hospital Anxiety and Depression Scale were done. The socio-economic level of the patients was assessed by socio-economic status scale.
Results
In the current study, 65.1% of the patients were highly adherent to their disease-modifying anti-rheumatic drug (DMARD) medications, while 26% showed middle level of adherence. There was a significant difference between medication adherence and anxiety, but not with other demographic data, clinical data, disease activity, or socio-economic level.
Conclusion
In this study, no significant difference was found between medication adherence and demographic, clinical, or socio-economic data. However, anxiety was significantly related to DMARD adherence in the studied group. Age and HAQ-DI were found to be strong predictors to medication adherence in our RA patients. Further studies should be conducted on a large number of patients with rheumatoid arthritis to become generalizable to a broader population.
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What are the risk factors of poor medication adherence in the target-to-treat era? Turk J Phys Med Rehabil 2019; 65:343-351. [PMID: 31893271 DOI: 10.5606/tftrd.2019.3071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/30/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to identify adherence rate and risk factors of poor adherence in patients with tightly controlled rheumatoid arthritis (RA) based on the treat-to-target (TTT) strategy. Patients and methods In this cross-sectional, observational study, a total of 103 patients (22 males, 81 females; mean age 58.6±9.5 years; range, 35 to 76 years) with tightly controlled RA between November 2016 and May 2017 were included. The patients were evaluated in terms of sociodemographic features, smoking and alcohol drinking status, body mass index (BMI), Disease Activity Score 28 (DAS28), and clinical and medication data. They filled out a series of standardized questionnaires including the Morisky 8-item Medication Adherence Scale (MMAS-8), Beck Depression Inventory (BDI), Mini-Mental State Examination (MMSE), and Health Assessment Questionnaire-Disability Index (HAQ-DI). Multiple multivariate linear regression analysis was used to identify variables which were possibly associated with the MMAS-8. Results Of the patients, 53 (51.5%) were non-adherent and 50 (48.5%) were adherent to medication. The DAS28-erythrocyte sedimentation rate, mean DAS28, HAQ, BDI scores, and the number of visits were higher and the MMSE scores were lower in non-adherent patients than adherent patients. In the linear multivariate analysis, significant associations were found between the MMAS-8 and MMSE, BDI, DAS28, and mean DAS28 scores. Conclusion Our study results show that the medication adherence rate is significantly higher compared to previous studies and high disease activity, depression, and cognitive dysfunction significantly affect medication adherence in this patient population.
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Cabral RTDS, Klumb EM, Carneiro S. Patients opinion and adherence to antimalarials in lupus erythematosus and rheumatoid arthritis treatment. J DERMATOL TREAT 2019; 31:264-269. [DOI: 10.1080/09546634.2019.1595504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Renata Tavares de Souza Cabral
- Ophthalmology Service, Retina and Vitreo Departamento, Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Evandro Mendes Klumb
- Rheumatology, FCM/UERJ, Rio de Janeiro, Brazil
- Rheumatology Sector, Pedro Ernesto University Hospital (HUPE – UERJ), State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sueli Carneiro
- Dermatology, School of Medical Sciences, State University of Rio de Janeiro (FCM/UERJ), Rio de Janeiro, Brazil
- Clementino Fraga Filho University Hospital/Federal University of Rio de Janeiro (HUCFF/UFRJ), Rio de Janeiro, Brazil
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Taibanguay N, Chaiamnuay S, Asavatanabodee P, Narongroeknawin P. Effect of patient education on medication adherence of patients with rheumatoid arthritis: a randomized controlled trial. Patient Prefer Adherence 2019; 13:119-129. [PMID: 30666095 PMCID: PMC6333161 DOI: 10.2147/ppa.s192008] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE There is a general understanding that patient educational interventions for enhancing medication adherence are important. However, their success at improving adherence is debatable. This study aimed to assess the influence of different modes of patient education on medication adherence in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS One hundred and twenty RA patients with non-adherence, defined as pill count ≥80% or medication-taking behavior questionnaire for Thai patient ≥23, were randomized by block randomization and assigned in a 1:1 allocation ratio to two study arms: multi-component intervention group or single intervention group. The multi-component intervention group received 30-minute directed counseling and a disease information pamphlet. The single intervention group received only a disease information pamphlet. The primary outcomes were an improvement in an adherence rate measured by pill count after 12 weeks. The Thai Clinical Trial Registry number is TCTR20171207003. RESULTS After 12 weeks, the pill count adherence rate increased significantly from baseline in both study groups. In the multi-component intervention group, adherence rate increased from 92.21±14.05 to 97.59±10.07 (P=0.002) and in the single intervention group, it increased from 88.60±19.66 to 92.42±14.27 (P=0.044). However, the mean difference between the multi-component intervention group and the single intervention group was not significant (5.38±12.90 vs 3.18±14.23, P=0.531). Clinical outcomes, including disease activity score 28, EuroQoL-5D, EuroQol visual analog scale, pain score, and physician global assessment were unchanged from baseline in both groups. CONCLUSION Patient education significantly improved adherence. However, there were no differences between single education intervention and multi-component education intervention in improving medication adherence. Provision of a disease information pamphlet with or without directed counseling can equally enhance medication adherence of patients with RA.
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Affiliation(s)
- Nichapa Taibanguay
- Division of Rheumatology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand,
| | - Sumapa Chaiamnuay
- Division of Rheumatology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand,
| | - Paijit Asavatanabodee
- Division of Rheumatology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand,
| | - Pongthorn Narongroeknawin
- Division of Rheumatology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand,
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11
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Pons-Estel BA, Bonfa E, Soriano ER, Cardiel MH, Izcovich A, Popoff F, Criniti JM, Vásquez G, Massardo L, Duarte M, Barile-Fabris LA, García MA, Amigo MC, Espada G, Catoggio LJ, Sato EI, Levy RA, Acevedo Vásquez EM, Chacón-Díaz R, Galarza-Maldonado CM, Iglesias Gamarra AJ, Molina JF, Neira O, Silva CA, Vargas Peña A, Gómez-Puerta JA, Scolnik M, Pons-Estel GJ, Ugolini-Lopes MR, Savio V, Drenkard C, Alvarellos AJ, Ugarte-Gil MF, Babini A, Cavalcanti A, Cardoso Linhares FA, Haye Salinas MJ, Fuentes-Silva YJ, Montandon de Oliveira E Silva AC, Eraso Garnica RM, Herrera Uribe S, Gómez-Martín D, Robaina Sevrini R, Quintana RM, Gordon S, Fragoso-Loyo H, Rosario V, Saurit V, Appenzeller S, Dos Reis Neto ET, Cieza J, González Naranjo LA, González Bello YC, Collado MV, Sarano J, Retamozo S, Sattler ME, Gamboa-Cárdenas RV, Cairoli E, Conti SM, Amezcua-Guerra LM, Silveira LH, Borba EF, Pera MA, Alba Moreyra PB, Arturi V, Berbotto GA, Gerling C, Gobbi CA, Gervasoni VL, Scherbarth HR, Brenol JCT, Cavalcanti F, Costallat LTL, Da Silva NA, Monticielo OA, Seguro LPC, Xavier RM, Llanos C, Montúfar Guardado RA, Garcia de la Torre I, Pineda C, Portela Hernández M, Danza A, Guibert-Toledano M, Reyes GL, Acosta Colman MI, Aquino AM, Mora-Trujillo CS, Muñoz-Louis R, García Valladares I, Orozco MC, Burgos PI, Betancur GV, Alarcón GS. First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR). Ann Rheum Dis 2018; 77:1549-1557. [PMID: 30045853 PMCID: PMC6225798 DOI: 10.1136/annrheumdis-2018-213512] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 11/24/2022]
Abstract
Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.
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Affiliation(s)
- Bernardo A Pons-Estel
- Departamento de Medicina Interna, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Eloisa Bonfa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Enrique R Soriano
- Sección de Reumatología, Servicio de Clínica Médica, Instituto Universitario, Escuela de Medicina, and Fundación Dr Pedro M Catoggio para el Progreso de la Reumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mario H Cardiel
- Centro de Investigación Clínica de Morelia, SC, Morelia, México
| | - Ariel Izcovich
- Servicio de Clínica Médica del Hospital Alemán de Buenos Aires, Hospital Alemán de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Federico Popoff
- Servicio de Clínica Médica del Hospital Alemán de Buenos Aires, Hospital Alemán de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan M Criniti
- Servicio de Clínica Médica del Hospital Alemán de Buenos Aires, Hospital Alemán de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gloria Vásquez
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Hospital Universitario, Fundación San Vicente, Medellín, Colombia
| | - Loreto Massardo
- Centro de Biología Celular y Biomedicina, Facultad de Medicina y Ciencia. Universidad San Sebastián, Santiago, Chile
| | - Margarita Duarte
- Departamento de Reumatología, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | | | - Mercedes A García
- Servicio de Reumatología, HIGA General San Martín, La Plata, Argentina
| | - Mary-Carmen Amigo
- Servicio de Reumatología, Centro Médico ABC, Ciudad de México, México
| | - Graciela Espada
- Servicio de Reumatología Infantil, Hospital de Niños Dr Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Luis J Catoggio
- Sección de Reumatología, Servicio de Clínica Médica, Instituto Universitario, Escuela de Medicina, and Fundación Dr Pedro M Catoggio para el Progreso de la Reumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Emilia Inoue Sato
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paul, Brazil
| | - Roger A Levy
- Discipline of Rheumatology, University of the State of Rio de Janeiro, Rio de Janeiro, Brasil
| | - Eduardo M Acevedo Vásquez
- Facultad de Medicina., Universidad Nacional Mayor de San Marcos. Servicio de Reumatología. Clínica San Felipe, J. María., Lima, Perú
| | - Rosa Chacón-Díaz
- Servicio de Reumatología, Policlínica Méndez Gimón, Caracas, Venezuela
| | | | | | | | - Oscar Neira
- Sección de Reumatología, Hospital del Salvador. Universidad de Chile. Unidad de Reumatología. Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo., Santiago, Chile
| | - Clóvis A Silva
- Pediatric Department, Faculdade de Medicina, Children's Institute, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Andrea Vargas Peña
- Clínica Reumatológica, Universidad de la República, and Unidad Docente Asistencial, Hospital Pasteur, Instituto Nacional de Reumatología., Montevideo, Uruguay
| | | | - Marina Scolnik
- Sección de Reumatología, Servicio de Clínica Médica, Instituto Universitario, Escuela de Medicina, and Fundación Dr Pedro M Catoggio para el Progreso de la Reumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo J Pons-Estel
- Departamento de Medicina Interna, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - Michelle R Ugolini-Lopes
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Verónica Savio
- Servicio de Reumatología, Hospital Italiano de Córdoba, Córdoba, Argentina
| | - Cristina Drenkard
- Division of Rheumatology, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, USA
| | | | - Manuel F Ugarte-Gil
- Servicio de Reumatología, Hospital General Guillermo Almenara Irigoyen, EsSalud., Lima, Perú
- Universidad Científica del Sur, Lima, Perú
| | - Alejandra Babini
- Servicio de Reumatología, Hospital Italiano de Córdoba, Córdoba, Argentina
| | - André Cavalcanti
- Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE), Recife, Brazil
| | - Fernanda Athayde Cardoso Linhares
- Clínica Reumatológica, Universidad de la República, and Unidad Docente Asistencial, Hospital Pasteur, Instituto Nacional de Reumatología., Montevideo, Uruguay
| | | | - Yurilis J Fuentes-Silva
- Unidad de Reumatología, Departamento de Medicina, Universidad de Oriente, Complejo Hospitalario Universitario Ruiz y Páez, Ciudad Bolívar, Venezuela
| | | | - Ruth M Eraso Garnica
- Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Sebastián Herrera Uribe
- Servicio de Reumatología, Hospital General de Medellín 'Luz Castro de Gutierrez' ESE, ARTMEDICA, Medellín, Colombia
| | - Diana Gómez-Martín
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Ciudad de México, Mexico
| | - Ricardo Robaina Sevrini
- Unidad de Enfermedades Autoinmunes Sistémicas, Facultad de Medicina, Clínica Médica 'C', Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Rosana M Quintana
- Departamento de Medicina Interna, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - Sergio Gordon
- Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas, HIGA Dr Oscar Alende, Mar del Plata, Argentina
| | - Hilda Fragoso-Loyo
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Ciudad de México, Mexico
| | - Violeta Rosario
- Servicio de Reumatología, Enfermedades Reumatológicas e Investigación Clínica (ERIC), Hospital Docente Padre Billini, Santo Domingo, Dominican Republic
| | - Verónica Saurit
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Simone Appenzeller
- Departamento de Clínica Médica, Disciplina de Reumatologia, Faculdade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil
| | | | - Jorge Cieza
- Servicio de Reumatología, Departamento de Especialidades Médicas, Hospital Nacional Edgardo Rebagliati Martins, EsSalud., Lima, Perú
| | - Luis A González Naranjo
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Hospital Universitario, Fundación San Vicente, Medellín, Colombia
| | | | - María Victoria Collado
- Servicio de Inmunología, Instituto de Investigaciones Médicas "Alfredo "Lanari", Ciudad Autónoma de Buenos Aires, Argentina
| | - Judith Sarano
- Servicio de Inmunología, Instituto de Investigaciones Médicas "Alfredo "Lanari", Ciudad Autónoma de Buenos Aires, Argentina
| | - Soledad Retamozo
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - María E Sattler
- Servicio de Reumatología, Hospital Escuela "Eva Perón", Granadero Baigorria, Argentina
| | - Rocio V Gamboa-Cárdenas
- Servicio de Reumatología, Hospital General Guillermo Almenara Irigoyen, EsSalud., Lima, Perú
| | - Ernesto Cairoli
- Unidad de Enfermedades Autoinmunes Sistémicas, Facultad de Medicina, Clínica Médica 'C', Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Silvana M Conti
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - Luis M Amezcua-Guerra
- Departamento de Inmunología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | - Luis H Silveira
- Departamento de Reumatología, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México
| | - Eduardo F Borba
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana A Pera
- Servicio de Reumatología, HIGA General San Martín, La Plata, Argentina
| | - Paula B Alba Moreyra
- Unidad de Reumatología, Cátedra de Clínica Médica I, Hospital Córdoba. Cátedra de Semiología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba., Córdoba, Argentina
| | - Valeria Arturi
- Servicio de Reumatología, HIGA General San Martín, La Plata, Argentina
| | - Guillermo A Berbotto
- Servicio de Reumatología, Hospital Escuela "Eva Perón", Granadero Baigorria, Argentina
| | - Cristian Gerling
- Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas, HIGA Dr Oscar Alende, Mar del Plata, Argentina
| | - Carla A Gobbi
- Unidad de Reumatología, Cátedra de Clínica Médica I, Hospital Córdoba. Cátedra de Semiología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba., Córdoba, Argentina
| | - Viviana L Gervasoni
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - Hugo R Scherbarth
- Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas, HIGA Dr Oscar Alende, Mar del Plata, Argentina
| | - João C Tavares Brenol
- Rheumatology Division, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernando Cavalcanti
- Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE), Recife, Brazil
| | - Lilian T Lavras Costallat
- Departamento de Clínica Médica, Disciplina de Reumatologia, Faculdade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil
| | - Nilzio A Da Silva
- Serviço de Reumatologia, Departamento de Clinica Medica, Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brazil
| | - Odirlei A Monticielo
- Rheumatology Division, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciana Parente Costa Seguro
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo M Xavier
- Rheumatology Division, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carolina Llanos
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rubén A Montúfar Guardado
- Departamento de Reumatología, Consultorio de Especialidades del Instituto Salvadoreño de la Seguridad Social, San Salvador, El Salvador
| | | | - Carlos Pineda
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, Mexico
| | | | - Alvaro Danza
- Grupo de Trabajo en Enfermedades Autoinmunes Sistémicas, Servicio de Clínica Médica, Facultad de Medicina, Universidad de la Republica, Hospital Pasteur, Administración de Servicios de Salud del Estado, Montevideo, Uruguay
| | - Marlene Guibert-Toledano
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ)., La Habana, Cuba
| | - Gil Llerena Reyes
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ)., La Habana, Cuba
| | - Maria Isabel Acosta Colman
- Departamento de Reumatología, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | - Alicia M Aquino
- Departamento de Reumatología, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | - Claudia S Mora-Trujillo
- Servicio de Reumatología, Departamento de Especialidades Médicas, Hospital Nacional Edgardo Rebagliati Martins, EsSalud., Lima, Perú
| | - Roberto Muñoz-Louis
- Servicio de Reumatología, Enfermedades Reumatológicas e Investigación Clínica (ERIC), Hospital Docente Padre Billini, Santo Domingo, Dominican Republic
| | | | - María Celeste Orozco
- Servicio de Reumatología, Instituto de Rehabilitación Psicofísica (IREP), Ciudad Autónoma de Buenos Aires, Argentina
| | - Paula I Burgos
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Graciela V Betancur
- Servicio de Reumatología, Instituto de Rehabilitación Psicofísica (IREP), Ciudad Autónoma de Buenos Aires, Argentina
| | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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Evaluation of treatment adherence in patients with Behçet's disease: its relation to disease manifestations, patients' beliefs about medications, and quality of life. Clin Rheumatol 2018; 38:761-768. [PMID: 30367312 DOI: 10.1007/s10067-018-4344-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/06/2018] [Accepted: 10/15/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION/OBJECTIVES Despite its importance, adherence to treatment has not been sufficiently studied in Behçet's disease (BD). The aim of this study was to evaluate medication adherence in BD using the Compliance Questionnaire of Rheumatology (CQR) and factors potentially affecting it. METHOD This cross-sectional study included 67 consecutive BD patients including 57 (85%) males with a mean age of 35.1 ± 9.27 years and mean disease duration of 129 ± 91 months. The cumulative clinical manifestations, the Behçet's Disease Current Activity Form (BDCAF) score, and the Vasculitis Damage Index (VDI) were recorded. The CQR, Socioeconomic Status Questionnaire for Health Research in Egypt (SES), the Beliefs about Medication Questionnaire (BMQ), and the Short Form 36 (SF-36) quality of life assessment questionnaire were administered to the patients. Linear regression analysis was done to determine independent predictors of CQR. RESULTS The mean BDCAF score was 3.27 ± 3.54 and the VDI was 3.36 ± 2.21. The mean CQR score was 69.2 ± 11.79. The CQR score varied significantly among different health sources (p = 0.02), with no relationship detected with other sociodemographic characteristics, nor with clinical characteristics or the SF-36. Among the investigated medications' complexities, severity of side effects showed significantly different CQR scores (p = 0.004), and a weak positive correlation between medications' numbers and the CQR was detected. Predictors for higher CQR scores included the necessity beliefs score of the BMQ (β = 1.1, p < 0.001); whereas, predictors for lower CQR scores were the harm and concern BMQ subscales ((β = - 1.5, p = 0.004) and (β = - 0.72, p = 0.032), respectively). CONCLUSIONS Beliefs about medications were the only predictor for adherence in our cohort.
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Chehab G, Sauer GM, Richter JG, Brinks R, Willers R, Fischer-Betz R, Winkler-Rohlfing B, Schneider M. Medical adherence in patients with systemic lupus erythematosus in Germany: predictors and reasons for non-adherence – a cross-sectional analysis of the LuLa-cohort. Lupus 2018; 27:1652-1660. [DOI: 10.1177/0961203318785245] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective Adherence to medication has a major impact on treatment control and success especially in chronic diseases but often remains unrecognized. Besides clinical, socioeconomic, disease-related and treatment-related parameters, general and personal health beliefs, as well as perception of health, can affect adherence. Our aim was to investigate the adherence to lupus-specific medications in German lupus patients and to assess influencing factors including detrimental or beneficial effects of health perceptions and beliefs. Methods The Lupus Erythematosus (LE) Long-Term Study (LuLa-study) is a nationwide longitudinal study among German Caucasian patients with systemic lupus erythematosus who have been assessed annually using a self-reported questionnaire since 2001. In 2013, we included questions concerning medical adherence (Morisky Medication Adherence Scale; MMAS-4), beliefs about medication prescribed (BMQ), illness perception and about the patients’ health locus of control (HLC). We present a cross-sectional analysis to assess predictors of adherence using a multivariable stepwise logistic regression. Results Five hundred and seventy-nine patients participated, 81 of whom did not take any lupus-specific medication and 40 of whom did not complete the MMAS-4 and were therefore omitted. Only 62.7% reported high adherence. Unintentional behaviour for low medical adherence exceeded the intentional behaviour by far. The use of azathioprine (OR: 1.85; 95% CI: 1.02–3.34), prednisone <7.5 mg (OR: 1.56; 95% CI: 0.97–2.49), a higher age (OR: 1.06; 95% CI: 1.03–1.08) and higher external HLC (OR: 1.15; 95% CI: 1.01–1.30) proved conducive for high adherence in our multivariable model. On the contrary, the general perception of medication being harmful or addictive (OR: 0.89; 95% CI: 0.82–0.97) was detrimental. Conclusion A low belief that one's own health is determined by healthcare providers (external HLC) and the belief of the harmfulness of medication were independent predictors of low adherence besides age and the choice of the medical agent. The recognition of these potential obstacles in physician–patient relationships is essential to ameliorate adherence. Provision of sufficient information and education might help to reach the best possible outcome.
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Affiliation(s)
- G Chehab
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - G M Sauer
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - J G Richter
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - R Brinks
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - R Willers
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - R Fischer-Betz
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - M Schneider
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Forsyth C, Kouvari M, D’Cunha NM, Georgousopoulou EN, Panagiotakos DB, Mellor DD, Kellett J, Naumovski N. The effects of the Mediterranean diet on rheumatoid arthritis prevention and treatment: a systematic review of human prospective studies. Rheumatol Int 2017; 38:737-747. [DOI: 10.1007/s00296-017-3912-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/12/2017] [Indexed: 12/27/2022]
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Campbell NKJ, Saadeldin K, De Vera MA. The Duality of Economic Issues With Medication Non-adherence in Patients With Inflammatory Arthritis. Curr Rheumatol Rep 2017; 19:66. [PMID: 28921409 DOI: 10.1007/s11926-017-0691-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW In this review, we synthesize current data on non-adherence across inflammatory arthritides and explore (1) the effects of economic factors on non-adherence and (2) the impacts of non-adherence on economic outcomes. RECENT FINDINGS Recent evidence demonstrates medication non-adherence rates as high as 74% in ankylosing spondylitis (AS), 90% in gout, 50% in psoriatic arthritis (PsA), 75% in systemic lupus erythematosus (SLE), and 82% in rheumatoid arthritis (RA). The effects of socioeconomic factors have been studied most in RA and SLE but with inconsistent findings. Nonetheless, the evidence points to having prescription coverage and costs of treatment as important factors in RA and education as an important factor in SLE. Limited data in AS and gout, and no studies of the effects of socioeconomic factors in PsA, show knowledge gaps for future research. Finally, there is a dearth of data with respect to the impacts of non-adherence on economic outcomes.
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Affiliation(s)
- Natasha K J Campbell
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, Canada
| | - Khalid Saadeldin
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
- Collaboration for Outcomes Research and Evaluation, Vancouver, Canada.
- Arthritis Research Canada, Richmond, BC, Canada.
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Goh H, Kwan YH, Seah Y, Low LL, Fong W, Thumboo J. A systematic review of the barriers affecting medication adherence in patients with rheumatic diseases. Rheumatol Int 2017; 37:1619-1628. [PMID: 28681249 DOI: 10.1007/s00296-017-3763-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/28/2017] [Indexed: 12/22/2022]
Abstract
Medication adherence is a crucial part in the management of rheumatic diseases, especially with many such patients requiring long-term medications. In this paper, we aim to systematically review the literature for the factors associated with medication adherence in the rheumatic patient population. We carried out a systematic literature search using PubMed®, PsychInfo® and Embase ® with relevant keywords and employed the PRISMA® criteria. We included English peer-reviewed articles that studied the factors affecting medication adherence in patients with rheumatic diseases, which were assessed by two independent reviewers. Hand searches were conducted and relevant factors were extracted and classified using the World Health Organization (WHO)'s five dimensions of medication adherence. A simple diagram was drawn to summarise the factors extracted. 1977 articles were identified and reviewed and 90 articles were found to be relevant. A total of 17 factors and 38 sub-factors were identified and categorized based on the WHO's five dimensions of medication adherence. A hand model for medication adherence was developed to succinctly summarise these dimension to remind clinicians the importance of medication adherence in daily practice. We conducted a systematic review on the various factors including patient, therapy, condition, health system and socioeconomic-related factors that affected medication adherence in rheumatic patients. We found 17 factors and 38 sub-factors that affected medication adherence in this population. This systematic review can facilitate future focused research in unexplored dimensions.
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Affiliation(s)
- Hendra Goh
- Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Yu Heng Kwan
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Department of Pharmacy, Khoo Teck Puat Hospital, Singapore, Singapore.
- Singapore Heart Foundation, Singapore, Singapore.
| | - Yi Seah
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Julian Thumboo
- Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Zhang L, Lu GH, Ye S, Wu B, Shen Y, Li T. Treatment adherence and disease burden of individuals with rheumatic diseases admitted as outpatients to a large rheumatology center in Shanghai, China. Patient Prefer Adherence 2017; 11:1591-1601. [PMID: 29075106 PMCID: PMC5609799 DOI: 10.2147/ppa.s144624] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE The purpose of this study was to determine treatment adherence and disease burden, analyze detailed medication problems experienced by patients, and identify factors associated with adherence in patients with rheumatic diseases in China. PATIENTS AND METHODS Patients with confirmed diagnoses of ankylosing spondylitis (AS), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE) were recruited, regardless of demographics, disease severity, and treatment characteristics. Adherence was assessed using the Compliance Questionnaire for Rheumatology and interview-based self-reports. A backwards-stepwise multivariate regression analysis was used to identify factors associated with adherence. RESULTS We collected data on 252 patients who had a rheumatic disease and visited our outpatient clinic in January or February of 2017. There were 121 patients with SLE, 70 with RA, and 61 with AS. The overall adherence rate was 41.7%, with 48.7% for SLE patients, 38.6% for RA patients, and 31.1% for AS patients. The overall EuroQol (EQ)-index was 0.761; AS patients had the best EQ-index (0.792), followed by those with SLE (0.780) and RA (0.700). SLE patients also had greater annual direct costs (US$5,103.58) than RA or AS patients. CONCLUSION Overall, 41.7% of our rheumatic disease patients were adherent to treatment, lower than in many other parts of the world. This indicates that it is important to identify methods that improve adherence in this population. It is particularly important to improve the health status and reduce the disease burden of patients with SLE, the most common of the three rheumatic diseases we analyzed. Our results suggest that reminder tools may improve adherence. Further prospective research is needed to confirm whether reminder tools and other measures can improve patient compliance.
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Affiliation(s)
- Le Zhang
- Department of Pharmacy, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Guo Hong Lu
- Department of Pharmacy, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shuang Ye
- Department of Rheumatology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bin Wu
- Department of Pharmacy, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yi Shen
- Department of Mathematics, Applied Statistics, Shanghai Jiaotong University, Shanghai, China
| | - Ting Li
- Department of Rheumatology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Correspondence: Ting Li, Department of Rheumatology, South Campus, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 2000 Jiangyue Road, Shanghai 201112, China, Tel +86 139 1692 7066, Fax +86 21 3450 6151, Email
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