Multilevel factors predict medication adherence in rheumatoid arthritis: a 6-month cohort study.
health care
health services research
outcome and process assessment
patient care team
Journal
Annals of the rheumatic diseases
ISSN: 1468-2060
Titre abrégé: Ann Rheum Dis
Pays: England
ID NLM: 0372355
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
received:
16
07
2021
accepted:
03
11
2021
pubmed:
1
12
2021
medline:
16
3
2022
entrez:
30
11
2021
Statut:
ppublish
Résumé
Non-adherence challenges efficacy and costs of healthcare. Knowledge of the underlying factors is essential to design effective intervention strategies. To estimate the prevalence of treatment adherence in rheumatoid arthritis (RA) and to evaluate its predictors. A 6-month prospective cohort study of patients with RA selected by systematic stratified sampling (33% on first disease-modifying rheumatic drug (DMARD), 33% on second-line DMARD and 33% on biologics). The outcome measure was treatment adherence, defined by a score greater than 80% both in the Compliance Questionnaire in Rheumatology and the Reported Adherence to Medication scale, and was estimated with 95% CIs. Predictive factors included sociodemographic, psychological, clinical, drug-related, patient-doctor relationship related and logistic. Their effect on 6-month adherence was examined by multilevel logistic models adjusted for baseline covariates. 180 patients were recruited (77% women, mean age 60.8). The prevalence of adherence was 59.1% (95% CI 48.1% to 71.8%). Patients on biologics showed higher adherence and perceived a higher medication need than the others; patients on second-line DMARDs had experienced more adverse events than the others. The variables explaining adherence in the final multivariate model were the type of treatment prescribed (second-line DMARDs OR=5.22, and biologics OR=3.76), agreement on treatment (OR=4.57), having received information on treatment adaptation (OR=1.42) and the physician perception of patient trust (OR=1.58). These effects were independent of disease activity. Treatment adherence in RA is far from complete. Psychological, communicational and logistic factors influence treatment adherence in RA to a greater extent than sociodemographic or clinical factors.
Identifiants
pubmed: 34844924
pii: annrheumdis-2021-221163
doi: 10.1136/annrheumdis-2021-221163
doi:
Substances chimiques
Antirheumatic Agents
0
Biological Products
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
327-334Investigateurs
Laura Garrido Courel
(LG)
Javier Mendizábal
(J)
Juliana Restrepo
(J)
Dolores Fábregas
(D)
Joana Atxotegi Saenz de Buruaga
(JA)
Javier Duruelo Etxebarrieta
(JD)
Nathali Rivas Zavaleta
(NR)
Eugenio Chamizo Carmona
(EC)
Lara Chaves
(L)
Sara Rojas
(S)
Francisca Sivera
(F)
Laura Casas Hernández
(LC)
Beatriz González Álvarez
(BG)
Antonio Gómez Centeno
(AG)
Eduard Graell
(E)
Mercedes Alperi
(M)
Susana Holgado
(S)
Melania Martinez Morillo
(MM)
Fermín Medina Varo
(FM)
Alba Pérez Linaza
(AP)
Isabel Serrano García
(IS)
Informations de copyright
© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: AB has received honoraria as speaker from Amgen, Gilead, Galapagos, Pfizer, Novartis, BMS, Nordic, Sanofi, Sandoz, Lilly, UCB and Roche. LC and MJGY have not received fees or personal grants from any laboratory, but their institute works by contract for laboratories among other institutions, such as Abbvie, Gebro Pharma, MSD, Novartis, Pfizer, Roche, Sanofi, Grünenthal and UCB.