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Clinical Rheumatology

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01-10-2019 | Ankylosing Spondylitis | Original Article

Qualitative assessment of medication adherence in patients with rheumatic diseases on biologic therapy

Authors: Sudha Raghunath, Raif Hijjawi, Elizabeth Hoon, E. Michael Shanahan, Fiona Goldblatt

Published in: Clinical Rheumatology | Issue 10/2019

Abstract

Introduction/objectives

Despite close management in specialized clinics, medication adherence remains a significant problem for some patients. The study aims to explore factors affecting medication adherence in patients attending a biologics clinic.

Method

Participants completed surveys including the Compliance Questionnaire Rheumatology (CQR) to quantify adherence rates. Purposive sampling targeting poorly adherent patients was used to select individuals for qualitative evaluation. Semi-structured interviews were performed and continued until saturation was achieved. Interviews were transcribed and coded using NVivo. Principles of grounded theory were used for data analysis.

Results

A total of 123 patients completed the survey (72 RA, 33 PsA, 18 AS). Of which, 96 patients completed all CQR items, of these 72% were identified as adequately adherent. A major theme which emerged from patient interviews was that the presence of active symptoms significantly influenced adherence. Patients tended not to prioritize medication taking until they had a recurrence of symptoms. Despite describing biologics as “life-changing”, patients expressed concern regarding potential long-term side effects of these medications which affected adherence. Patients identified their relationship with their rheumatologist as pivotal and perceived diet, exercise and stress as critical. Intentional factors were the predominant drivers for non-adherence; patients made a risk-benefit analysis based on their beliefs and chose to not take their medications as prescribed.

Conclusions

Medication adherence to traditional and biological therapies was lower than expected by treating clinicians in this patient group, who are closely supported in a dedicated biologics clinic. Several of the identified themes suggest that shared decision making and enhancing patient education may improve adherence in this group.

Key Points

• Adherence rates are suboptimal even in supported, educated, English-speaking patients in the biologics era.

• Contributing factors were ‘intentional’ as patients chose to be non-adherent based on their beliefs.

• Emergent themes suggest that enhancing patient education could improve adherence.

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Title: Qualitative assessment of medication adherence in patients with rheumatic diseases on biologic therapy
Authors: Sudha Raghunath
Raif Hijjawi
Elizabeth Hoon
E. Michael Shanahan
Fiona Goldblatt
Publication date: 01-10-2019
Publisher: Springer London
Keywords: Ankylosing Spondylitis
Psoriatic Arthritis
Rheumatoid Arthritis
Published in: Clinical Rheumatology / Issue 10/2019
Print ISSN: 0770-3198
Electronic ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-019-04609-y

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