FRI0212 What Are the Effects of Interventions Targetting Medication Adherence in Rheumatic Diseases: A Systematic Review

• Published in: Annals of the rheumatic diseases Vol. 73; no. Suppl 2; p. 459
• Main Authors: De Vera, M.A., Galo, J.
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2014
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2014-eular.4753

Background Recent medication adherence rates reported as low 30% in rheumatoid arthritis (RA),1 49% in systemic lupus erythematosus (SLE),1 and 17% in gout2 highlight the importance of understanding how health care providers can intervene and support patients. To date, there are no synthesis of the evidence on interventions targeting medication adherence and their effectiveness in rheumatology patients. Objectives To systematically review studies of interventions targeting medication adherence in rheumatic diseases Methods We searched Medline, Embase, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials databases. We considered controlled, uncontrolled, prospective, retrospective, randomized, and non-randomized studies of interventions conducted among patients with rheumatic diseases (e.g., RA, SLE, psoriatic arthritis [PsA], gout). Medication adherence must be reported as a primary or secondary outcome. We classified interventions according to target (patient vs. provider), implementation (generalized vs. tailored), and focus (educational vs. behavioural vs. affective) and related these factors with reported effects. Results Few studies met inclusion criteria – 4 in RA, 1 in RA and PsA, 1 in RA, PsA and inflammatory polyarthritis, and 1 in SLE (Table). Three studies in RA patients showed significant effects of a group patient meeting, one-on-one patient meeting, and cognitive behavioural therapy, respectively. Similarities across interventions are patient-tailored approaches that combine educational and affective methods. Three studies in RA patients alone or in RA, PsA, and/or inflammatory polyarthritis showed non-significant effects. A single study in SLE showed positive effects of patient counselling. Table 1. Studies of medication adherence intervention(s) in patients with rheumatic diseases Study Study design Patients N (Int/Con) Follow up Intervention Medication(s) Adherence (Rates/Trend/Questionnaire score) Outcome Score (Int Grp) Score (Cont Grp) Significance Brus 1998 RCT RA 25/30 12 mo group patient education SSZ pill counts rate: 89% rate: 84% NS Hill 2001 RCT RA 51/49 6 mo one-on-one patient meetings DPA plasma phenobarbitone rate: 85% rate: 55% S Evers 2002 RCT RA 32/32 12 mo cognitive behavioural treatment DMARDs questionnaire (3=best) 2.85 2.59 S Homer 2009 Piot RCT RA, PsA 30/32 12 mo group counselling MTX, SSZ, LEF pill counts 69% 90% S Rudd 2009 RCT RA, PsA, inflammatory polyarthritis 64/63 12 mo individualized care not indicated questionnaire (0=best) 0.17 0.18 NS van den Bemt 2011 Within-subject cohort RA 50/50 report on patient's adherence DMARDs Compliance Questionnaire Rheumatology 72% 78% NS Ganachari 2012 RCT SLE 21/20 2 mo patient counselling NSAID, HCQ, GC Modified Morisky Scale (6=best) 5.8 4.6 S Conclusions Despite consistent data on medication non-adherence in rheumatic diseases, there is limited and inconsistent literature on adherence interventions. Further research on interventions to improve medication adherence among rheumatology patients is needed. References de Achaval S, Suarez-Almazor ME. Treatment adherence to disease-modifying antirheumatic drugs in patients with rheumatoid arthritis and systemic lupus erythematosus. International Journal of Clinical Rheumatology. 2010;5:313-326. Zandman-Goddard G, Amital H, Shamrayevsky N, Raz R, Shalev V, Chodick G. Rates of adherence and persistence with allopurinol therapy among gout patients in Israel. Rheumatology. Jun 2013;52(6):1126-1131. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4753