Background Medication adherence in patients with rheumatoid arthritis (RA) is suboptimal, with adherence rates between 30% to 80%. Existing interventions to improve medication adherence are mostly complex and have small effect sizes. We therefore developed a short, group-based intervention to change the balance in necessity and concern beliefs about medication, and to improve adherence to Disease Modifying Anti Rheumatic Drugs (DMARDs) in non-adherent RA patients.
Objectives This randomized clinical trial assessed the effect of a group-based intervention on patients’ balance in beliefs about medication (primary outcome, measured with the BMQ: beliefs about medicine questionnaire), and medication adherence.
Methods Adult, non-adherent (determined with the CQR: Compliance Questionnaire on Rheumatology) RA patients using DMARDs were randomized into the intervention arm, consisting of two motivational interviewing based group sessions led by a pharmacist, a homework assignment, and a follow-up call, or into the control arm, in which participants received brochures about their currently used DMARDs. Measurements were conducted at baseline, and at one week, six months and 12 months follow-up. Generalized Estimating Equations were used to estimate intervention effects.
Results 123 patients, (mean age: 60 years, 69% female) were randomized. No differences in improvement in medication adherence, and in the change in the balance between necessity and concern beliefs about medication were detected between the two arms. Only at 12 months follow-up, participants in the control arm had stronger necessity beliefs about medication than participants in the intervention arm (b and 95% CI indicating this difference, corrected for baseline and with control group as reference category: -1.1 (-2.0 - -0.2)).
Conclusions Our group-based intervention neither changed the beliefs about medication, nor improved medication adherence to DMARDs in non-adherent patients with rheumatoid arthritis.
References Van den Bemt BJF, Zwikker HE, Van den Ende CHM (2012). Medication adherence in patients with rheumatoid arthritis: a critical appraisal of the existing literature. Expert Rev. Clin. Immunol. 8(4), 337–351.
Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2008; CD000011.
Zwikker H, Van den Bemt B, Van den Ende C, Van Lankveld W, Den Broeder A, Van den Hoogen F et al. (2012). Development and content of a group-based intervention to improve medication adherence in non-adherent patients with rheumatoid arthritis. Patient Education and Counseling, 89: 143–151.
Disclosure of Interest None Declared
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