The influence of behavioural and psychological factors on medication adherence over time in rheumatoid arthritis patients: a study in the biologics era

Abstract

Objectives. To investigate levels of self-reported adherence to biologic treatment and establish the contribution of demographic, physical and psychological factors to biologic medication adherence in an RA cohort.Methods. Adalimumab-treated patients were recruited through the British Society for Rheumatology Biologics Register for RA between May 2007 and April 2009. Demographic and baseline psychological measures including illness and medication beliefs were collected. Disease activity (28-item DAS), physical function (HAQ) and quality of life (36-item Short Form Health Survey) were also measured at baseline and at 6, 12 and 18 months. Adherence was assessed at each follow-up using the patient self-completed Compliance Questionnaire for Rheumatology (CQR). Multilevel mixed effects modelling analysis was performed to investigate predictors of adherence.Results. Of the 329 Adalimumab-treated patients included, low adherence (CQR score <65) was reported in 23%, with 41% reporting low adherence at at least one time point. After controlling for age and disease duration, factors independently predictive of increased adherence were increased belief in medication necessity, with baseline effect diminishing over time [β coefficient 1.68 (s.e. 0.19), P = 0.0001], lower medication concerns [0.50 (0.15), P = 0.001], with this effect remaining throughout follow-up, increased professional or family member support [0.81 (0.32), P = 0.01], strong views of illness being chronic [0.32 (0.14), P = 0.025] and increased treatment control [0.41 (0.19), P = 0.032].Conclusion. Wider recognition of the importance of psychological factors, particularly medication beliefs, in driving medication adherence could have substantial clinical and health economic benefits in RA. The psychological factors we have identified are putative targets for strategies to improve adherence in RA.

Factors affecting medication adherence among patients with rheumatic disorders

“…Studies have shown that early and aggressive treatment with disease modifying anti-rheumatic medications can minimize inflammation and cause low disease activity and sometimes remission. [4,[21][22][23] Such patients are usually from the point of diagnosis expected to incorporate a medication regimen into their daily lives, for the rest of lives. The introduction of chronic medication into a patient's life often means that new behavioral patterns need to be established but if the message is not clear, for any factors, accurately understood by the patient; the patients' well-being is further compromised.…”

“…[4,14,15] Besides undesirable influence on clinical outcomes, non-adherence would also cause an increased financial load for society. 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.…”

“…The notion of adherence proposes an alliance relationship, whereby therapeutic guidance should be agreed upon between patient and health care providers, thus recognizing partial autonomy of the patient or an active role in collaboration with a prescriber with regard to how treatment is followed. [4,8,12] Non-adherence refers to discontinuation or failure of proper medication intake without prior approval from the treating health-care providers. Also, "non-adherence" encompasses the diverse factors for patients not following a treatment recommendation.…”

“…Therefore, it is pivotal for those patients to get proper management following the onset diagnosis of rheumatic disease symptoms "i.e., window of opportunity" and throughout the course of disease, these to enhance a patient's ability to work and carry out the daily responsibilities, avoid long-term complications and disability, can prohibit damage to joints and other organs, enhance long term function and raise the likelihood of achieving disease remission. [3,4] Subsequently, medication adherence is a critical challenge in the management of all chronic diseases, especially rheumatic disorders. As this type of health problems require longlasting medication to improve symptoms and prevention of deterioration of the disease.…”

“…Also, improving medication adherence enhances patients' safety and health condition. [4] The literature revealed many studies that looked at the effect of disease, health teaching about process of disease, rehabilitation program, as well as the various medications used. However, not enough of these studies include factors affecting medication adherence among patients especially with rheumatic disorders.…”