Medication Adherence in Patients with Rheumatoid Arthritis: The Effect of Patient Education, Health Literacy, and Musculoskeletal Ultrasound

Abstract

Background. Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting <1% of the population. Incompletely controlled RA results in fatigue, joint and soft tissue pain, progressive joint damage, reduced quality of life, and increased cardiovascular mortality. Despite an increasing range of disease modifying agents which halt disease progression, poor patient adherence with medication is a significant barrier to management. Objective. The goal of this review was to examine the effectiveness of measures to improve patient medication adherence. Methods. Studies addressing treatment adherence in patients with RA were identified by trawling PsycINFO, Medline, Cochrane, Pubmed, and ProQuest for studies published between January 2000 and October 2014. Articles were independently reviewed to identify relevant studies. Results. Current strategies were of limited efficacy in improving patient adherence with medications used to treat RA. Conclusion. Poor medication adherence is a complex issue. Low educational levels and limited health literacy are contributory factors. Psychological models may assist in explaining medication nonadherence. Increasing patient knowledge of their disease seems sensible. Existing educational interventions appear ineffective at improving medication adherence, probably due to an overemphasis on provision of biomedical information. A novel approach to patient education using musculoskeletal ultrasound is proposed.

Factors affecting medication adherence among patients with rheumatic disorders

“…In addition, besides direct financial effect, medication non-adherence would have indirect cost implications due to loss of productivity, without even mentioning the substantial negative effect on patient's quality of life. [1] Studies comprehending five decades have estimated that 20% to 50% of patients do not adhere to prescribed therapeutic regimen as directed. According to WHO (2003), in developed countries, non-adherence of patients with chronic conditions is around 50%, being probably higher in developing countries.…”

“…Although efficient managements for improving medication adherence are necessary, factors affecting medication adherence remains a poorly studied phenomenon and must be considered firstly. [1,10] Nurses are considered the linking entity between health care providers and patients as well as the most designated member of the healthcare team to assess patient adherence. Nonadherence to treatment regimen is a persistent challenge to nurses.…”

“…Under this umbrella of arthritis, there are over 30 inflammatory rheumatic diseases including rheumatic arthritis, Behcet syndrome, systemic lupus erythematous, gout, scleroderma, osteoarthritis and various forms of systemic vasculitis including gaint cell arteritis. [1,2] Also, several studies pointed out that rheumatic diseases can cause severe deformities and activity limitations for at least 30% of patients. While simple task such as walking can cause pain and be difficult or even impossible, therefore 60% of patients are unable to work 10 years after the beginning of illness.…”

“…However, not enough of these studies include factors affecting medication adherence among patients especially with rheumatic disorders. [1,16] Thus, study represents my attempt to "walk in their shoes" and begin to determine factors affecting medication adherence among patients with rheumatic disorders.…”

What is Health Literacy? How to measure it? Why is it important?

“…13 Kronik hastalıklarla SOY ilişkisi irdelendiğinde, böbrek hastalıkları, astım ve KOAH, Tip 2 Diyabet, romatoid artrit ve depresyon nedeniyle izlenen bireylerde, düşük SOY nedeniyle bariyerlerin oluştuğu ve bunların aşılmasının gerekliliğine vurgu yapılmaktadır. [12][13][14][15][16] Koruyucu sağlık hizmetleri yönünden SOY ilişkisi değerlendiğinde, düşük SOY düzeyinin tarama testlerinin uygulanması açısından önemli bir engel olduğu görülmektedir. Örneğin, İngiltere'de kolon kanseri tarama programında, bireylerle ilk iletişim yolu olarak evlerine tarama hakkında bilgi içeren yazılı bir materyal gönderilmektedir.…”