Looking beyond sociodemographic, clinical factors for predicting RA treatment adherence
medwireNews: Psychologic, communicational, and logistic factors are the main determinants of treatment adherence among patients with rheumatoid arthritis (RA), study findings suggest, highlighting the impact of both patient- and physician-related factors on adherence.
“Studies on adherence focus mainly on patient-related determinants, often neglecting other elements of the process, such as the attitude of the professionals, or system barriers,” say the researchers who therefore set out to measure the interplay between patient- and physician-related factors on treatment adherence.
The cohort study included 180 patients with rheumatoid arthritis from 10 randomly selected Spanish tertiary or secondary care centers. A third of the study participants were taking their first conventional DMARD, another third was taking a second-line conventional DMARD, and the remaining third were taking a biologic.
At the 6-month follow-up, the prevalence of adherence was 59.1%, where adherence was defined by a score of 80.0% or higher on the Compliance Questionnaire for Rheumatology and the Reported Adherence to Medication scales. In patients taking their first or second conventional DMARD, the prevalence of adherence was 43.1% and 70.4%, respectively, while the adherence rate in those taking a biologic was 64.4%.
“These values are in line with the WHO estimate of adherence in chronic diseases,” note Loreto Carmona (Instituto de Salud Musculoesquelética, Madrid, Spain) and colleagues.
On multivariate analysis, the patient-related factor most closely associated with adherence was agreement between patient and physician on treatment, with a significant odds ratio (OR) of 4.32, followed by prescription of hospital-administered treatment (OR=2.54) and receiving information on the possibility of adapting treatment to their needs (OR=1.44).
The key physician-related factor was the type of treatment prescribed, with adherence a significant 4.24 and 3.39 times more likely among patients taking a second-line conventional DMARD or a biologic, respectively, than among those taking first-line conventional DMARDs. Physicians providing information on the efficacy of treatment was also an important determinant of treatment adherence, with a significant OR of 1.60.
When the researchers looked at the interplay between patient- and physician-related factors, the main variables that explained adherence overall were the type of treatment prescribed (second-line conventional DMARD or a biologic vs first-line conventional DMARD; ORs=4.72 and 3.50, respectively), agreement on treatment between the patient and physician (OR=4.29), taking nonsteroidal anti-inflammatory drugs (OR=4.21), and receiving information from the physician on treatment efficacy (OR=1.71) and on adapting treatment according to the needs of patients (OR=1.54).
By contrast, receiving information on practical aspects was associated with a reduced likelihood of adherence, with a significant OR of 0.66.
The effects of these factors on adherence were independent of disease activity, the researchers note.
The inclusion of physician factors has “helped confirm an interplay between patient-related and physician-related factors, highlighting the importance of communication and information as main determinants of adherence,” say Carmona and team in the Annals of the Rheumatic Diseases.
The team concludes: “[O]ur results support the concept that adherence is not just an individual characteristic but rather a complex and dynamic experience in which each part—patient, healthcare physician and the community—plays a specific role.”
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