Discordance between doctor and patient assessments and non-adherence to subcutaneous biological drugs

Otón, Teresa; Carmona, Loreto; Urruticoechea‐Arana, Ana; Calvo‐Alén, Jaime; Arteaga, María Jesús Soler; Cea‐Calvo, Luis

doi:10.1007/s00296-019-04304-w

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…Planning and enacting the strategy for treatment requires a degree of mutual understanding, which is difficult to build when there are discordant views, particularly on disease activity and therapy. Nonadherence to T2T owing to patient preferences and differences in patient–provider assessment of disease impact were outlined in a TRACTION trial report [51], which is consistent with other studies [30,52,53]. Although patient choice is undeniably important, it should not pose a significant barrier to optimal treatment strategies.…”

Section: Communication and Personalized Caresupporting

confidence: 65%

Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis

Batko

Krzanowski

et al. 2019

JCM

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Principles of treat-to-target (T2T) have been widely adopted in both multinational and regional guidelines for rheumatoid arthritis (RA). Several questionnaire studies among physicians and real-world data have suggested that an evidence–practice gap exists in RA management. Investigating physician adherence to T2T, which requires a process measure, is difficult. Different practice patterns among physicians are observed, while adherence to protocolized treatment declines over time. Rheumatologist awareness, agreement, and claims of adherence to T2T guidelines are not always consistent with medical records. Comorbidities, a difficult disease course, communication barriers, and individual preferences may hinder an intensive, proactive treatment stance. Interpreting deviations from protocolized treatment/T2T guidelines requires sufficient clinical context, though higher adherence seems to improve clinical outcomes. Nonmedical constraints in routine care may consist of barriers in healthcare structure and socioeconomic factors. Therefore, strategies to improve the institution of T2T should be tailored to local healthcare. Educational interventions to improve T2T adherence among physicians may show a moderate, although beneficial effect. Meanwhile, a proportion of patients with inadequately controlled RA exists, while management decisions may not be in accordance with T2T. Physicians tend to be aware of current guidelines, but their institution in routine practice seems challenging, which warrants attention and further study.

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Section: Communication and Personalized Caresupporting

confidence: 65%

Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis

Batko

Krzanowski

et al. 2019

JCM

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“…The concerns and priorities of patients with RA are primarily pain management, along with alleviating joint damage, functional impairment, fatigue, and other symptoms, 11,12 while disease activity assessments conducted by the attending physicians involve a wide range of objective measures for rheumatoid synovitis, including TJC, SJC, acute‐phase reactants, 12–15 and affected joint distribution 8 . Accordingly, previous cross‐sectional studies, including our previous cross‐sectional study, 8 have demonstrated that pain and functional disability perceived by patients are major contributors to positive discordance between PGA and PhGA 5–7,12–17 …”

Section: Introductionmentioning

confidence: 95%

“…8 Accordingly, previous cross-sectional studies, including our previous cross-sectional study, 8 have demonstrated that pain and functional disability perceived by patients are major contributors to positive discordance between PGA and PhGA. [5][6][7][12][13][14][15][16][17] However, few longitudinal studies have investigated the shift in PGA-PhGA discordance over time in patients with RA. 9,18,19 Karpouzas et al investigated this shift over 2 years in 536 Hispanic patients with established RA and demonstrated that positive discordance was stable over time and that its presence at baseline increased the likelihood of positive discordance at subsequent visits.…”

Section: Introductionmentioning

confidence: 99%

Clinical variables, including novel joint index, associated with future patient‐physician discordance in global assessment of rheumatoid arthritis (RA) disease activity based on a large RA database in Japan

et al. 2022

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Background: Discordance between patient global assessment (PGA) and physician global assessment (PhGA) of rheumatoid arthritis (RA) disease activity is mainly determined by pain and functional disabilities. This study aimed to investigate the shift in PGA-PhGA discordance and the variables associated with future positive discordance (PGA > PhGA) based on the NinJa database in Japan. Methods:We examined 7557 adults with RA registered in both NinJa 2014 and 2018, with a discordance cutoff of 3 on a 10-cm scale. The affected joint distribution was investigated using the joint indices x, y, and z, which were calculated as indices for the upper joint, lower joint, and large joint involvement, respectively. The variables in NinJa 2014 that were associated with positive discordance in NinJa 2018 were examined using binary stepwise logistic regression analysis.Results: Due to the small number of patients with RA categorized as having negative discordance (PGA < PhGA), we focused on patients with RA categorized as having either concordance or positive discordance. Logistic regression analysis revealed that positive discordance in NinJa 2018 was associated with age, pain, modified Health Assessment Questionnaire (mHAQ) score, corticosteroid use, and existent positive discordance and was inversely associated with C-reactive protein (CRP) and x at baseline (NinJa 2014). The same findings were observed when patients with RA were divided based on the discordance status at baseline. Persistence (positive discordance to positive discordance) was associated with pain and mHAQ scores but inversely associated with CRP.

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“…Esto supone que el 26,2 % de los pacientes no son adherentes a al menos uno de sus medicamentos. Este valor se queda muy por debajo del 50 % que estima la OMS (13) Originales valores muy distintos en función de la patología estudiada y la metodología empleada (15)(16)(17)(18)(19)(20). La respuesta más plausible para esta diferencia es que muchos pacientes retiran los medicamentos, pero luego no los toman, por las razones que sean.…”

Section: Discusionunclassified

¿Por qué los pacientes no retiran todos los medicamentos y productos sanitarios que les son prescritos por el médico?

Mas¹,

Ripoll²,

Alonso³

et al. 2019

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Introducción: la e-receta finalizó su implantación en la Comunidad Valenciana (CV) en septiembre de 2013, observándose que el paciente no retiraba parte de los medicamentos que tenía prescritos, por lo que se diseña un estudio para estudiar las diversas incidencias que pudieran ser la causa. Objetivos: analizar y cuantificar las incidencias detectadas en la dispensación de las e-receta prescritas a los pacientes en farmacia comunitaria de la CV. Métodos: estudio observacional, transversal, prospectivo multicéntrico de base poblacional de las incidencias detectadas en las dispensaciones de las e-receta. Población diana: pacientes mayores de 18 años o cuidadores. Resultados: se registraron 22.983 solicitudes de medicamentos o productos sanitarios (MPS) correspondientes a 6.621 pacientes. De los MPS disponibles para ser dispensados se rechazaron un 12,0 %. • Las discrepancias entre lo que el médico prescribió y el paciente entendió supusieron el 19,0 % de los rechazos. • Las distintas razones relacionadas con el incumplimiento fueron el 32,3 % de los medicamentos rechazados (MR). • En aquellos medicamentos en los que el paciente debía pagar una aportación el rechazo fue ligeramente mayor (12,2 %) que en el caso de los que no. Conclusiones: la dispensación de MPS prescritos a través de la e-receta permite identificar problemas relacionados con medicamentos (PRM) que inciden sobre la falta de adherencia y las discrepancias con lo prescrito en la receta electrónica. Why do patients not withdraw all the medicines and health products prescribed to them by the doctor?

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Discordance between doctor and patient assessments and non-adherence to subcutaneous biological drugs

Cited by 5 publications

References 15 publications

Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis

Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis

Clinical variables, including novel joint index, associated with future patient‐physician discordance in global assessment of rheumatoid arthritis (RA) disease activity based on a large RA database in Japan

¿Por qué los pacientes no retiran todos los medicamentos y productos sanitarios que les son prescritos por el médico?

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