Background Adherence is defined as the extent to which the patient continues the agreed-upon mode of treatment under limited supervision when faced with conflicting demands. Adding a biological agent to a classical DMARD in a mixed regime represents a major milestone for rheumatic patients: in addition to the perceived risks of nonbiologicals, such patients accept new future risks associated with biological therapy. Usually doctors pay a supplementary attention to listen and answer to patient concerns’ about biological DMARD that create an inequality of information and disfavor nonbiological DMARDs. As a consequence such patients that use mixed therapy may change their minds regarding what is best to treat their disease. In addition the perceived effect of new therapy, social support, level of education, and age also contribute to adherence. Furthermore, drug tolerability appears to affect adherence too. Some data regarding adherence might be extracted from the registers but patient’s perceptions are not captured in these: this study intended to improve the knowledge around this issue and add information about reasons of nonadherence to mixed regimes.
Objectives To identify patients’ related causes of non-adherence to a mixed regime usually not captured in largest registers.
Methods In a focus group exercise we identified 21 factors for noncompliance to mixed regime in rheumatic patients. In a literature search we reviewed the data regarding the information available in biological registers around each of these factors. We selected the following factors that might influence adherence to a mixed treatment and are not covered (enough) in registers: patient’s opinion regarding the total number of drugs that have to use, patient’s thoughts regarding the efficacy of added biological-DMARD, patient’s fear of biological and non-biological DMARDs, patient’s hope in curative effect of biological and non-biological DMARDs. A structured questionnaire have been developed and delivered to 50 rheumatic patients consecutive admitted. Statistic analyses have been done with SPSS 16.0
Results We coded the responders in two categories: good compliance (all or almost all drug doses used) and poor compliance (many to almost all doses lost). 26.3% patients of the good compliance group consider the number of drugs they take as being too large and 58.3% from poor compliance group have the same idea (p<0.01). Patient’s thoughts regarding the efficacy of added biological-DMARD was similar in both groups (89 vs. 83%, p>0.05 are happy with added biological DMARDs). Patient’s fear of biological and non-biological DMARDs was similar regarding biological DMARDs (less than 10% are seriously worried about risks of biological therapy) and slightly higher for classical DMARDs in good compliance group. Patient’s hope in curative effect of biological is higher in good compliance group (index of hope = 92 vs. 53 in poor compliance group). Additional analyses have been done regarding cortisone and patient characteristics.
Conclusions Patient’s compliance to a mixed regime might be influenced by patient’s personal thoughts; these factors might be added in the core of biological registers in order to understand better patient’s behavior.
Disclosure of Interest None Declared
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