Background Recent medication adherence rates reported as low 30% in rheumatoid arthritis (RA),1 49% in systemic lupus erythematosus (SLE),1 and 17% in gout2 highlight the importance of understanding how health care providers can intervene and support patients. To date, there are no synthesis of the evidence on interventions targeting medication adherence and their effectiveness in rheumatology patients.
Objectives To systematically review studies of interventions targeting medication adherence in rheumatic diseases
Methods We searched Medline, Embase, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials databases. We considered controlled, uncontrolled, prospective, retrospective, randomized, and non-randomized studies of interventions conducted among patients with rheumatic diseases (e.g., RA, SLE, psoriatic arthritis [PsA], gout). Medication adherence must be reported as a primary or secondary outcome. We classified interventions according to target (patient vs. provider), implementation (generalized vs. tailored), and focus (educational vs. behavioural vs. affective) and related these factors with reported effects.
Results Few studies met inclusion criteria – 4 in RA, 1 in RA and PsA, 1 in RA, PsA and inflammatory polyarthritis, and 1 in SLE (Table). Three studies in RA patients showed significant effects of a group patient meeting, one-on-one patient meeting, and cognitive behavioural therapy, respectively. Similarities across interventions are patient-tailored approaches that combine educational and affective methods. Three studies in RA patients alone or in RA, PsA, and/or inflammatory polyarthritis showed non-significant effects. A single study in SLE showed positive effects of patient counselling.
Conclusions Despite consistent data on medication non-adherence in rheumatic diseases, there is limited and inconsistent literature on adherence interventions. Further research on interventions to improve medication adherence among rheumatology patients is needed.
de Achaval S, Suarez-Almazor ME. Treatment adherence to disease-modifying antirheumatic drugs in patients with rheumatoid arthritis and systemic lupus erythematosus. International Journal of Clinical Rheumatology. 2010;5:313-326.
Zandman-Goddard G, Amital H, Shamrayevsky N, Raz R, Shalev V, Chodick G. Rates of adherence and persistence with allopurinol therapy among gout patients in Israel. Rheumatology. Jun 2013;52(6):1126-1131.
Disclosure of Interest None declared
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