Effect of patient education on medication adherence of patients with rheumatoid arthritis: a randomized controlled trial

Abstract

PurposeThere is a general understanding that patient educational interventions for enhancing medication adherence are important. However, their success at improving adherence is debatable. This study aimed to assess the influence of different modes of patient education on medication adherence in patients with rheumatoid arthritis (RA).Materials and methodsOne hundred and twenty RA patients with non-adherence, defined as pill count ≥80% or medication-taking behavior questionnaire for Thai patient ≥23, were randomized by block randomization and assigned in a 1:1 allocation ratio to two study arms: multi-component intervention group or single intervention group. The multi-component intervention group received 30-minute directed counseling and a disease information pamphlet. The single intervention group received only a disease information pamphlet. The primary outcomes were an improvement in an adherence rate measured by pill count after 12 weeks. The Thai Clinical Trial Registry number is TCTR20171207003.ResultsAfter 12 weeks, the pill count adherence rate increased significantly from baseline in both study groups. In the multi-component intervention group, adherence rate increased from 92.21±14.05 to 97.59±10.07 (P=0.002) and in the single intervention group, it increased from 88.60±19.66 to 92.42±14.27 (P=0.044). However, the mean difference between the multi-component intervention group and the single intervention group was not significant (5.38±12.90 vs 3.18±14.23, P=0.531). Clinical outcomes, including disease activity score 28, EuroQoL-5D, EuroQol visual analog scale, pain score, and physician global assessment were unchanged from baseline in both groups.ConclusionPatient education significantly improved adherence. However, there were no differences between single education intervention and multi-component education intervention in improving medication adherence. Provision of a disease information pamphlet with or without directed counseling can equally enhance medication adherence of patients with RA.

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update

“…During discussion, the importance of shared decision-making was reiterated and the importance of patient education emphasised. Indeed, patient education may increase adherence to medication49; moreover, education of rheumatologists may foster adherence to appropriate assessment strategies 50. There were suggestions made to expand this item by mentioning the importance of patient education separately, but there was ultimate agreement that patient education forms the implicit and inseparable basis for shared decision-making.…”

<p>Non-Adherence to Prescribed Antihypertensives in Primary, Secondary and Tertiary Healthcare Settings in Islamabad, Pakistan: A Cross-Sectional Study</p>

“…This is in line with previous research which showed the significant relationship between formal education and medication adherence. 48,49 The number of medications had a significant correlation with medication adherence. Medication adherence increases when the patient is using more than one medication to control blood pressure.…”

Pharmacy hydroxyurea education materials for patients with sickle cell disease: An environmental scan and assessment of accuracy

“…Pharmacists routinely provide patients with information sheets that contain an exhaustive review of side effects of HU and special handling instructions, given that HU is classified as a cytotoxic drug . Although limited data exist regarding the sources of information that pediatric patients with SCD and their families use to inform their decision‐making surrounding medication acceptance, previous studies have found a positive association between accurate patient education about therapy and adherence . Written information materials in particular have been shown to contribute to patient decision‐making regarding therapy initiation in several other disease states and serve as an influential adjunct to patient counseling.…”

“…20 Although limited data exist regarding the sources of information that pediatric patients with SCD and their families use to inform their decision-making surrounding medication acceptance, previous studies have found a positive association between accurate patient education about therapy and adherence. 15,21 Written information materials in particular have been shown to contribute to patient decision-making regarding therapy initiation in several other disease states [22][23][24] and serve as an influential adjunct to patient counseling. Therefore, the goal of this study was to evaluate the written material provided to patients with SCD by pharmacies to gain a better understanding of the information available to patients and to compare this information to a reference standard HU patient information handout (PIH) for patients with SCD.…”