A randomized controlled trial of the Effects of a telehealth educational intervention on medication adherence and disease activity in rheumatoid arthritis patients

Abstract

Aims To examine the effects of a tailored telehealth educational intervention on medication adherence and disease activity in discharged patients with rheumatoid arthritis (RA). Design An un‐blinded randomized controlled trial. Methods A total of 92 eligible patients were recruited from January 2015–December 2015. Participants were randomly assigned to either the intervention (N = 46) or control group (N = 46). The intervention group received four educational sessions delivered through a telephone across a 12‐week intervention. The content of the education mainly included: subject's knowledge about disease; treatment goals; the importance of taking medication correctly; side effect management; remembering to take medication. The control group received only standard care including discharge instructions. Outcome measures included medication adherence and disease activity. Results The intervention group had significantly higher medication adherence compared with the control group at 12th and 24th week. There was no significant difference between two groups in disease activity at 12th and 24th week. Conclusions The telephone‐delivered tailored educational intervention effectively improved medication adherence among discharged patients with rheumatoid arthritis. However, no significant benefits of the intervention on disease activity were detected. Impact Good medication adherence in rheumatoid arthritis patients contributes to controlling symptom and inflammation, preventing the progressive structural damage. This study demonstrated that the telehealth educational intervention could improve patients' medication adherence but did not have a direct impact on clinical condition in the short‐term. The intervention for discharged patients with rheumatoid arthritis can be integrated into the clinical setting by the nursing staff as follow‐up care. Trial registration number: ChiCTR‐IPR‐14005722.

Tele-health interventions to support self-management in adults with rheumatoid arthritis: a systematic review

“…One study was assessed to have high risk of attrition bias as the data was incomplete [24]. All studies were unclear or at high risk of bias in most domains, common issues included small numbers of participants and a lack of blinding [20][21][22][23].…”

“…Other high risk of bias included participation bias as only those who had a telephone or mobile phone were recruited [20][21][22][23]. The studies were of low-to-moderate quality affecting overall validity, reliability and generalisability.…”

“…Theories underpinning each intervention were identified and summarised in the TIDieR intervention Table 4. This mainly outlined cognitive-behavioural approaches, including self-efficacy theory [18,23], empowerment theory, social support theory [18], theory of planned behaviour [19], dual process theory [19,21,23], and health belief theory [21]. A treat to target approach was mentioned as a key component of supporting self-management in two studies [20,24].…”

“…Each intervention was delivered as planned with the overall aim of supporting self-management in individuals with RA. Two web-based interventions [18,19] and three telephone interventions were based on blended educational and behavioural theory [21][22][23]. Allam et al [18] & Zuidema et al [19] supported self-management through providing education and information on RA helping individuals to self-manage symptoms by targeting beliefs to affect behaviours.…”

Implementation by smokers of the recommendations made during the systematic screening of comorbidities associated with chronic inflammatory diseases in daily practice

“…Cependant, la totalité des recommandations sur l'ostéoporose n'a pas été suivie. Une meilleure prise en charge de l'ostéoporose aurait dû être observée d'autant plus que les courriers d'hospitalisation de jour sont également envoyés au rhumatologue traitant.Les études ont essentiellement évalué l'efficacité de l'éducation thérapeutique dans les RIC concernant l'adhérence thérapeutique[92][93][94] mais peu concernant l'adhérence à des recommandations. L'adhérence thérapeutique non optimale chez les patients atteints de RIC a été plusieurs fois mise en évidence dans des études récentes[88,89,95].…”