Psychosocial predictors of DMARD adherence in the first three months of treatment for early arthritis. Issue 1 (January 2017)

• Record Type: Journal Article
• Authors: Pasma, Annelieke; Hazes, Johanna M.W.; Busschbach, Jan J.V.; van der Laan, Willemijn H.; Appels, Cathelijne; de Man, Yaël A.; Nieboer, Daan; Timman, Reinier; van 't Spijker, Adriaan
• Is Part Of: Patient education and counseling. Volume 100:Issue 1(2017)
• Page Start: 126
• Page End: 132
• Publication Date: 2017-01
• Subjects: Adherence -- DMARDs -- Early arthritis -- Psychosocial factors; Patient education -- Periodicals; Health counseling -- Periodicals; Health education -- Periodicals; Counseling -- Periodicals; Patient Education -- Periodicals; Éducation des patients -- Périodiques; Counseling -- Périodiques; Éducation sanitaire -- Périodiques; 615.5071
• DOI: 10.1016/j.pec.2016.07.019
• Languages: English
• ISSNs: 0738-3991

Abstract

Highlights: Patients who limit activities because of their disease are more prone to non-adherence. The patient's autonomy may be an important requisite for adherence behavior. Adherence is in the first months of DMARD treatment high, but declines over time. Abstract: Objectives: To induce disease remission, early arthritis patients should adhere to their disease-modifying antirheumatic drugs (DMARD) in the first months after diagnosis. It remains unknown why some patients are non-adherent. We aimed to identify patients at risk for non-adherence in the first 3 months of treatment. Methods: Adult DMARD-naive early arthritis patients starting synthetic DMARDs filled out items on potential adherence predictors at baseline. Adherence was measured continuously. Non-adherence was defined as not opening the electronically monitored pill bottle when it should have been. Items were reduced and clustered using principal component analysis. The most discriminating items were identified with latent trait models. We used a multivariable logistic regression model to find non-adherence predictors. Results: 301 patients agreed to participate. Adherence was high and declined over time. Principal component analysis led to 7 dimensions, while subsequent latent trait models analyses led to 15 dimensions. Two dimensions were associated with adherence, one dimension was associated with non-adherence. Conclusions: Information seeking behavior and positive expectations about the course of the disease are associated with adherence. Patients who become passive because of pain are at risk for non-adherence. Practice implications: Rheumatologists have cues to identify non-adherence, and may intervene on non-adherence through implementing shared decision making techniques.