Rheumatoid Arthritis
Factors associated with adherence to pharmaceutical treatment for rheumatoid arthritis patients: A systematic review

https://doi.org/10.1016/j.semarthrit.2012.12.001Get rights and content

Abstract

Objectives

To identify factors associated with adherence to medication for rheumatoid arthritis or undifferentiated inflammatory arthritis using a systematic literature search.

Methods

PubMed, PsycINFO, EMbase and CINAHL databases were systematically searched from inception to February 2011. Articles were included if they addressed medication adherence, used a reproducible definition, determinants and its statistical relationship. Methodological quality was assessed using a quality assessment list for observational studies derived from recommendations from Sanderson et al. (2007) [12]. Resulting factors were interpreted using the Health Belief Model (HBM).

Results

18 out of 1479 identified studies fulfilled the inclusion criteria. 64 factors were identified and grouped according to the HBM into demographic and psychosocial characteristics, cues to action and perceived benefits versus perceived barriers. The belief that the medication is necessary and DMARD use prior to the use of anti-TNF had strong evidence for a positive association with adherence. There is limited evidence for positive associations between adherence and race other than White, general cognition, satisfactory contact with the healthcare provider and the provision of adequate information from the healthcare provider. There is limited evidence for negative associations between adherence and having HMO insurance, weekly costs of TNF-I, having a busy lifestyle, receiving contradictory information or delivery of information in an insensitive manner by the rheumatologist. 18 factors were unrelated to adherence.

Conclusions

The strongest relation with adherence is found to be prior use of DMARDs before using anti-TNF and beliefs about the necessity of the medication. Because the last one is modifiable, this provides hope to improve adherence.

Section snippets

Literature search

EMbase, PubMed, CINAHL and PsycINFO databases were searched from inception to February 2011 to identify studies on factors affecting medication adherence in patients with RA (see search strategy in Appendix 1. Studies were eligible if they (i) addressed medication adherence in adult RA or undifferentiated inflammatory arthritis patients, (ii) evaluated factors related to adherence, (iii) used a reproducible definition or validated instrument to measure adherence, and (iv) provided a statistical

Results

Out of the 1479 identified studies, 135 articles were potentially relevant regarding the content of title and abstract and retrieved as full-text articles. After applying the inclusion criteria 17 articles remained eligible for the review. One relevant additional study was identified from the reference lists, resulting in 18 included studies (see flowchart Fig. 1). Data were extracted from each study and summarized in Table 3, Table 4, Table 5, Table 6 and presented in full detail in the

Discussion

Our study used a systematic literature search to identify and summarize data on adherence rates in RA and undifferentiated inflammatory arthritis, to identify factors influencing adherence to pharmaceutical treatment and to identify the strength of the association between these factors and adherence. Overall 18 studies that fulfilled the inclusion criteria examined the relationship between adherence and factors thought to influence adherence, of which none studied undifferentiated inflammatory

References (36)

  • E. Salt et al.

    Adherence to disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: a narrative review of the literature

    Orthop Nurs

    (2010)
  • D.C. Park et al.

    Medication adherence in rheumatoid arthritis patients: older is wiser

    J Am Geriatr Soc

    (1999)
  • World Health Organization. Adherence to long-term therapies: evidence for action. Geneva, Switzerland;...
  • S.D. Achaval et al.

    Treatment adherence to disease-modifying antirheumatic drugs in patients with rheumatoid arthritis and systemic lupus erythematosus

    Int J Clin Rheumatol

    (2010)
  • I.M. Rosenstock et al.

    Social learning theory and the Health Belief Model

    Health Educ Quart

    (1988)
  • S. Sanderson et al.

    Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliograph

    Int J Epidemiol

    (2007)
  • M. van Tulder et al.

    Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group

    Spine

    (2003)
  • B.J. van den Bemt et al.

    Adherence rates and associations with nonadherence in patients with rheumatoid arthritis using disease modifying antirheumatic drugs

    J Rheumatol

    (2009)
  • Cited by (133)

    View all citing articles on Scopus
    View full text