Trust in physician critical to drug adherence in RA, gout, osteoporosis
Medication adherence for patients with rheumatoid arthritis, gout and osteoporosis was heavily influenced by the degree of trust patients had in their physician, as well as medication properties and patient capabilities, according to data published in Arthritis Care & Research.
“Nonadherence is complex and multifactorial and taking long-term medications for rheumatic conditions is challenging,” Ayano Kelly, MBBS, FRACP, of the Australian National University College of Health and Medicine, and colleagues wrote. “No adherence strategy has been effective across all patients, conditions and settings. It remains uncertain whether existing adherence interventions address the priorities and concerns of patients with rheumatic conditions.”
To identify and rank factors important to patients and caregivers related to drug adherence in gout, osteoporosis and RA, Kelly and colleagues recruited 82 adult participants from five rheumatology clinics in New South Wales, Australia, for a series of 14 focus groups. The participants included 15 caregivers and 67 patients, of whom 25 had gout, 37 had RA and 20 had osteoporosis. Sixteen participants had more than one diagnosis, including 10 with osteoporosis and RA, three with gout and osteoporosis, two with gout and RA and one with all three conditions.
The researchers used focus groups and modified nominal group techniques during a period from February to October 2018 to develop patient and caregiver priorities. The modified nominal group technique included structured discussion to generate a list of ideas, followed by a single round of individual ranking. Later, the focus groups allowed participants to explain the reasons behind their choices.
In addition, they were encouraged to share experiences with medications, involvement in decision making and adherence strategies. Participants then discussed factors important to adherence. Each factor was scored in terms of importance on a scale of 0 to 1
According to the researchers, the overall top five most important factors were trust in doctor, with importance score 0.46; drug effectiveness, with a score of 0.31; doctor's knowledge, with a score of 0.25; side effects, at 0.23; and medication-taking routine, at 0.13. However, the ranking varied depending on whether the participant was a patient or caregiver. Trust in the physician ranked highest among patients, whereas side effects were the chief concern among caregivers.
Participants’ reasoning for their views were narrowed down into five themes: Motivation and certainty in supportive individualized care; living well and restoring function; fear of toxicity and cumulative harm; seeking control and involvement; and unnecessarily difficult and inaccessible.
“Patient and caregivers’ experience with their medications is complex,” Kelly and colleagues wrote. “Factors related to the doctor, medication properties and patient knowledge and medication taking routine were perceived to be important regarding adherence.”
“Enhancing doctor-patient relationships, balancing medication benefits and harms within the context of an individual’s unique set of comorbidities and goals, and empowering patients with medication knowledge and skills are potential solutions that require further investigation,” they added. “Understanding and addressing patient-important factors in adherence could enhance the use of medications to help patients live well with their rheumatic conditions.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.