Background In rheumatoid arthritis (RA), up to 80% of patients were found to be non-adherent to prescribed medication and non-pharmacological recommendations. These patients do not achieve an optimal clinical outcome.
Objectives In the present study, we therefore explored predictors that may lead to non-adherence to both medicines and/or non-pharmacological recommendations.
Methods In a mixed methods study, retrospective observational data from patients meeting the ACR/EULAR criteria for RA who were non-attenders/missed the routine check up visits for at least 9 months to the rheumatology clinic and had had an initial DMARD therapy were queried of the databases of two rheumatology centers in Austria (Graz, Vienna). Subsequently, we invited all patients to take part in a qualitative semi-structured interview study with a meaning condensation data analysis. In the interviews, patients were assigned to the subgroups “adherent” (e.g. having regular rheumatology visits in another clinic) or “non-adherent” (e.g. having stopped taking the prescribed medication). Possible predictors derived from the qualitative analysis and the retrospective observational data were then tested in a logistic regression model.
Results In total, data of 459 patients (346 [75.4%] females; mean age 63.0 [SD± 14.8]) were extracted out of the databases. 131 patients (109 [83.2%] females; mean age 64.8 [SD± 14.1]) participated in the qualitative interviews. In addition to already known themes, new topics arose from the analysis: (i) patient's dogma inhibited adherent behavior, in that patients felt that pain was an important part of life and attributed to having had a high manual workload during life of which patients were proud; (ii) patients had less trust in physicians when they were seeking support from other physicians, because they appeared to be “young or unexperienced”; (iii) Some patients did not feel properly understood if physicians only prescribed medication without giving advice on non-pharmacological aspects of treatment.
Two clinical variables were found to be predictors for non-adherent behavior (table 1): swollen joint count (patients with higher numbers of swollen joints were less adherent) and age (younger patients were less adherent).
Conclusions In order to achieve a good clinical outcome, it is important to provide evidence based treatment recommendations, but also to ensure adherence to these. The predictors found in our study could be used to enhance patient adherence and therefore improve clinical outcome.
Acknowledgements This project was partially funded by AbbVie Inc.
Disclosure of Interest None declared
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