Effectiveness of a group-based intervention to change medication beliefs and improve medication adherence in patients with rheumatoid arthritis: A randomized controlled trial

Zwikker, Hanneke; Ende, C.H. van den; Lankveld, Wim G. van; Broeder, Alfons A den; Hoogen, F.H. van den; Mosselaar, Birgit van de; Dulmen, Sandra van; Bemt, Bart Jf van den

doi:10.1016/j.pec.2013.12.002

Cited by 62 publications

(60 citation statements)

References 45 publications

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“…Similar improvement in medication adherence and disease activity was reported by many authors in the intervention group compared with the control group 27,30,31 . This was in contrary to a recent study which tested the effect of a motivational interviewing programme on medication adherence in RA patients and did not demonstrate any significant change to patient beliefs about medications or in improving medication adherence and this may be due to focusing on patient-related factors only 32 . Other interventional studies failed to improve medication adherence were reported 33,34 .…”

Section: Discussioncontrasting

confidence: 99%

Evaluation of Adherence to Drug Treatment in Patients with Rheumatoid Arthritis

Alhefny

El-Rahman

El-Moteleb

et al. 2015

Egypt J of Rheumatol & Clinical Immunol

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Objectives: The aim of this study was to measure the frequency of medication adherence in rheumatoid arthritis (RA) patients and to assess factors affecting it, deal with some factors to improve adherence and reevaluate after six months. Methods: A prospective cohort interventional study of 100 patients with RA under treatment fulfilled the American College of Rheumatology / European League against Rheumatism (ACR/EULAR) criteria. All patients subjected to full history taking including socio-demographic data, medication and clinical examination, Assessment of disease activity by DAS28, functional ability by Health Assessment Questionnaire (HAQ) score, pain by Visual Analogue Scale (VAS) scale, adherence to treatment by Compliance Questionnaire of Rheumatology (CQR) and Power Doppler U/S for both metacarophalangeal and wrist joints were done at baseline and after 6 months at the end of the study. Analysis of factors of non-adherence was done at baseline before intervention. Results: The baseline adherence rate (CQR≥80) was 37%. The cost of medication (62%), non-availability of medication in pharmacy (59%), lack of belief in the benefit of treatment (38%) forgetting the medication (37%) ,poor provider-patient relationship (25%), inadequate follow up (23%) and polypharmacy (20%) were the most common causes of non adherence in non adherent patients (p˂ 0.05). Adherent patients to drug treatment were younger, living inside Cairo, with higher level of education and nonsmoker. Non-adherent patients had longer morning stiffness duration (p=0.013), more tender joints, higher DAS28 and HAQ scores, higher ESR and CRP titer (p<0.001) and higher frequency of active synovitis in Doppler ultrasound. They also had significantly more frequency of having medications on their expense (p<0.001). After 6 months of follow up and trying to correct the causes of non-adherence, the adherence rate increased to 69% and this associated with improvement in disease activity, functional state and ultrasongraphic findings. Conclusion: Adherence rate to drug treatment in RA patients at baseline was low (37%). It was associated with higher disease activity, functional disability. Patient education, financial support, good physician-patient relationship and simplification of the prescription were found to improve the patient adherence to treatment and to control disease activity after follow up. [Egypt J Rheumatology & Clinical Immunology, 2016; 4(1): 81-92]

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Section: Discussioncontrasting

confidence: 99%

Evaluation of Adherence to Drug Treatment in Patients with Rheumatoid Arthritis

Alhefny

El-Rahman

El-Moteleb

et al. 2015

Egypt J of Rheumatol & Clinical Immunol

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“…One study 59 did not find that targeting beliefs about medication had any effect on DMARD adherence. Another study 60 found that supplying a nonadherent patient's rheumatologist with a report about medication use and adherence did not change adherence or the patient's beliefs about medicine.…”

Section: Discussionmentioning

confidence: 99%

Adherence and Persistence with Methotrexate in Rheumatoid Arthritis: A Systematic Review

Curtis

Bykerk

Aassi³

et al. 2016

J Rheumatol

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Objective.Medication adherence in patients with rheumatoid arthritis (RA) is typically suboptimal. Nonadherence has been associated with symptom worsening and increased disability. We systematically reviewed published clinical studies to evaluate methotrexate (MTX) adherence and persistence, factors associated with MTX adherence and persistence, and the effect of MTX nonadherence on clinical outcomes in RA.Methods.MEDLINE and Embase were systematically searched (inception to February 2016) using relevant keywords. Observational or interventional clinical studies in patients with RA that specifically reported adherence to or persistence with MTX were included. Data were extracted using a predesigned, standardized template that included study design, patient demographics, and relevant outcomes. Main outcomes were MTX adherence and persistence rates in patients with RA treated with MTX and factors associated with MTX adherence and persistence.Results.Of 365 references screened, 31 articles met inclusion criteria and another 10 were identified from searching reference lists. Estimates of MTX adherence varied from study to study because of heterogeneity in patient populations, duration of followup, definitions of adherence, and methods of assessment. Rates of MTX persistence ranged from 50% to 94% at 1 year and 25% to 79% at 5 years. No clear trends were identified in factors that influence MTX adherence and persistence. Two studies suggested that MTX adherence was associated with superior clinical outcomes.Conclusion.MTX adherence and persistence are highly variable in patients with RA. Research is necessary to determine the effect of nonadherence on health outcomes and to identify independent predictors of nonadherence to inform evidence-based interventions.

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“…The most common limitations reported by authors regarding threats to validity were: generalizability, inclusion of subjects with high adherence at baseline, 18,20,24,25,28,30,31 lack of statistical power, 15-19, 28, 30, 32 and recall bias and social desirability for studies reporting only self-reported measures 16,23 and including only subjects with low adherence leading to a recruitment challenge. 17 The authors offered adequate explanations on how they dealt with these limitations with the exception of social desirability, which remains as a possible source of bias for those two studies.…”

Section: Quality Of the Studies And Evaluation Of Biasmentioning

confidence: 99%

Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis

et al. 2016

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BACKGROUND: Randomized clinical trials (RCTs), mostly conducted among minority populations, have reported that motivational interviewing (MI) can improve medication adherence. OBJECTIVES: To evaluate the impact of MI and of the MI delivery format, fidelity assessment, fidelity-based feedback, counselors' background and MI exposure time on adherence. DATA SOURCES: We searched the MEDLINE database for studies published from 1966 until February 2015. STUDY ELIGIBILITY CRITERIA: We included RCTs that compared MI to a control group and reported a numerical measure of medication adherence. DATA SYNTHESIS: The main outcome was medication adherence defined as any subjective or objective measure reported as the proportion of subjects with adequate adherence or mean adherence and standard deviation. For categorical variables we calculated the relative risk (RR) of medication adherence, and for continuous variables we calculated the standardized mean difference (SMD) between the MI and control groups. RESULTS: We included 17 RCTs. Ten targeted adherence to HAART. For studies reporting a categorical measure (n = 11), the pooled RR for medication adherence was higher for MI compared with control (1.17; 95 % CI 1.05-1.31; p < 0.01). For studies reporting a continuous measure (n = 11), the pooled SMD for medication adherence was positive (0.70; 95 % CI 0.15-1.25; p < 0.01) for MI compared with control. The characteristics that were significantly (p < 0.05) associated with medication adherence were telephonic MI and fidelity-based feedback among studies reporting categorical measures, group MI and fidelity assessment among studies reporting continuous measures and delivery by nurses or research assistants. Effect sizes differed in magnitude, creating high heterogeneity. CONCLUSION: MI improves medication adherence at different exposure times and counselors' educational level. However, the evaluation of MI characteristics associated with success had inconsistent results. Larger studies targeting diverse populations with a variety of chronic conditions are needed to clarify the effect of different MI delivery modes, fidelity assessment and provision of fidelity based-feedback.KEY WORDS: adherence; behavioral medicine; patient engagement.

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Effectiveness of a group-based intervention to change medication beliefs and improve medication adherence in patients with rheumatoid arthritis: A randomized controlled trial

Abstract: Absent intervention effects might have been due to, amongst others, selection bias and a suboptimal treatment integrity level. Hence, targeting beliefs about medication in clinical practice should not yet be ruled out.

Cited by 62 publications

References 45 publications

Evaluation of Adherence to Drug Treatment in Patients with Rheumatoid Arthritis

Evaluation of Adherence to Drug Treatment in Patients with Rheumatoid Arthritis

Adherence and Persistence with Methotrexate in Rheumatoid Arthritis: A Systematic Review

Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis

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