Background Injectable biologic medications have become part of the routine treatment rheumatoid arthritis (RA), and other inflammatory arthritides. While revolutionizing arthritis care, they are associated with potentially serious risks. Patients must receive adequate education on disease states, medication administration, common and side effects, and when to contact a health care professional with problems.
Objectives Examine the sources from which information concerning biological drug safety is obtained by patients. Identify specific knowledge gaps concerning biologic drug administration and crucial aspects of safety
Methods We identified a random group of patients receiving injectable biological therapies and seen at 2 different clinical settings. Surveys were administered by telephone that captured basic demographics, disease characteristics, and current and past biologics used. We assessed the type (healthcare provider (HCP) /non-HCP), and method (written material, 1-on-1, internet-based) of education received regarding drugs and disease, satisfaction with education, and the level of retained medical knowledge concerning critical aspects of injectable biologics. Questions covered injection technique, storage and handling, side effects, signs of infection, and what to do for elective surgery. Questions were asked using Visual Analog Scales (VAS), Likert scales, with additional comments recorded. Frequencies were compared using Chi-square (X2) tests. We calculated odds ratios of satisfactory medication safety knowledge (answered all questions correctly) using logistic regression adjusted for demographics (age, sex, race).
Results Forty-eight subjects participated: 88% women, 19% minority, 46% with high school (HS) education or less. Overall disease duration was 7.6±7.1 years, 67% had RA, and 73% were receiving their 1st biologic. Primary sources of education regarding medications and side effects were variable (MD, nurse, other medical professional, internet, other), but 57% reported that their primary education regarding drugs and safety came from a nurse. Participants correctly identified appropriate injection sites, technique, and storage and handling of biologics 100% of the time. There was considerable variability in knowledge concerning basic aspects of relevance to biologic safety. Among the overall group 30% were unable to correctly answer all 4 knowledge questions concerning biologic safety issues related to infections, elective surgery, and when to contact the rheumatologist. Level of education (≤HS vs >HS) was not associated with medication safety knowledge (X2 1.05, p=0.31). Patients who had received their education from a nurse were more likely to answer all questions correctly (X2 8.20, p<0.01). Safety knowledge was significantly associated with receiving biologic education from a nurse (OR 8.9, 95%CI 1.9, 42.4, p=0.006) after adjustment for demographic characteristics.
Conclusions Critical gaps in knowledge exist regarding safe use of biologics. HCPs bear responsibility for educating patients about the safety aspects of biologic medications. In this small study, education provided by a nurse was associated with greater knowledge by patients. Further study is needed to identify the optimal methods of delivering patient education that will be applicable across care settings and to develop a standardized patient curriculum.
Disclosure of Interest None declared