SP0038\u2005FACTORS IMPORTANT FOR MEDICAL ADHERENCE

Abstract

Factors important for medical adherence in rheumatic diseases Disease-modifying antirheumatic drugs (DMARDs) are the cornerstone for the treatment of inflammatory arthritis and fundamental to prevent radiologic progression in patients with rheumatoid/psoriatic arthritis. However, the full benefit of DMARDs can only be achieved if patients follow prescribed treatment regimens. Adherence, or the extent to which patients take medications as prescribed, is however low in chronic medical conditions: approximately 50% of all people with chronic medical conditions do not adhere to their prescribed medication regimens [1,2]. Previous research in patients with rheumatic diseases vary from 30% to 107%, depending on the used measurement method [7]. Thus, improving adherence to DMARDs could dramatically improve the efficacy of drug therapy in rheumatic diseases and reduce costs. However, so far, interventions designed to improve medication adherence are only partly effective in changing medication-taking behaviour [2-5]. To be able to improve adherence, factors should be known that are associated with medication adherence in RA. This will help us to target non-adherent patients and design interventions to improve adherence. Although several studies have examined factors associated with adherence to treatment with DMARDs, hardly any variable was found to be consistently and strongly related to adherence. [6-7]. Despite this, there is evidence that especially patient”s need to take medication, prior DMARD use, patient”s self-efficacy and information delivered to the patient might be associated with medication adherence. Overall, two types of non-adherent behaviour are commonly observed: unintentional (due to forgetfulness, regimen complexity or physical problems) and intentional (when the patient decides not to take the treatment as instructed). In case of intentional non-adherence, the decision to take medication is based on a cost benefit analysis weighing the costs/risks of the treatment against the perceived benefits. This implicates that health care professionals should individually assess patient”s (un)intentional barriers to take medication and target medication adherence interventions on patient”s individual barriers. Thus, besides tackling (unintentional) practical barriers, such as forgetfulness (with for example reminder services), clinicians should also be sensitive to patient”s personal beliefs that might impact medication adherence, and should discuss with their patient any concerns that they raise about prescribed medications. This lecture will give insight in the latest insights in the research of factors important for medication adherence and their practical consequences for adherence improving interventions in clinical practice. Reference: [1] Sabate E, ed. Adherence to long-term therapies: evidence for action. Geneva, World Health Organization, 2003. [2] Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, Agoritsas T, Mistry N, Iorio A, Jack S, Sivaramalingam B, Iserman E, Mustafa RA, Jedraszewski D, Cotoi C, Haynes RB. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014;(11) [3] Galo JS, Mehat P, Rai SK, Avina-zubieta A, Vera MA De. What are the effects of medication adherence interventions in rheumatic diseases: a systematic review. Ann rheum Dis. 2016;75: 667–673. [4] Demonceau J, Ruppar T, Kristanto P, Hughes DA, Farger E, Kardas P, et al. Identification and assessment of adherence-enhancing interventions in studies assessing medication adherence through electronically compiled drug dosing histories: a systematic literature review and meta-analysis. Drugs. 2013;73: 545–562. [5] Lavielle M, Puyraimond-zemmour D, Romand X, Gossec L, Senbel E, Pouplin S, et al. Methods to improve medication adherence in patients with chronic inflammatory rheumatic diseases: a systematic literature review. RMD Open. 2018;4: 1–8. [6] Van den Bemt BJ, Zwikker HE, van den Ende CH. Medication adherence in patients with rheumatoid arthritis: a critical appraisal of the existing literature. Expert Rev Clin Immunol. 2012;8(4):337-51. [7] Pasma A, van”t Spijker A, Hazes JM, Busschbach JJ, Luime JJ. Factors associated with adherence to pharmaceutical treatment for rheumatoid arthritis patients: a systematic review. Semin Arthritis Rheum. 2013 Aug;43(1):18-28. doi: 10.1016/j.semarthrit.2012.12.001. Epub 2013 Jan 24. Disclosure of Interests: Bart van den Bemt Grant/research support from: UCB, Pfizer, Abbvie; Speakers bureau: Pfizer, AbbVie, UCB, Biogen, Sandoz, Consultant for: UCB, Novartis and Pfizer