Adherence in RA Patients is Based on Perceived Necessity

Attitudes about rheumatoid arthritis (RA) medication from clinicians can impact a patient’s adherence and psychological factors, according to research published in Patient Preference and Adherence.

A collaborative team of researchers from the Netherlands and Norway conducted a cross sectional study in order to examine the associations between beliefs about medication and non adherence in patients with RA. In particular, they looked at RA patients using disease modifying anti rheumatic drugs (DMARDs) and their potential psychological impact. Patients were eligible to participate if they had been living with RA for over a year, older than age 18 years, or using one or more DMARD. Rheumatologists saw patients between September 2009 and September 2010 and administered questionnaires to 580 willing participants of the 820 who were eligible.

The topics covered in the survey included the perceived need to take medication (necessity beliefs), the concerns about taking medication (concern beliefs), general medication beliefs, and attitudes toward taking medication. Medication non adherence was also assessed, along with demographical, clinical, and psychological factors in each patient.

The participants were 68 percent female with a mean age of 63 years. About a third (30 percent) indicated they were non adherent to their medication. The majority of participants used 1 DMARD and had been living with RA for a median duration of 14 years. Non adherence indicators were weaker necessity beliefs and an unfavorable balance between necessity and concern beliefs. Having an indifferent attitude toward adherence importance also contributed to adherence prevalence in patients. There was no statistical significance in adherence beliefs among demographical, clinical, or psychological factors.

“Having weaker necessity beliefs about medication was the only Beliefs about Medicines Questionnaire (BMQ) construct that was independently associated with both Compliance Questionnaire Rheumatology (CQR) and Medication Adherence Report Scale (MARS) non adherence,” the authors wrote in the paper. “The strength of the associations was considerable... This implies that necessity beliefs about medication are a sensible target for adherence improving interventions.”

The results of this study are in alignment with only some of the previous studies done on RA medication adherence. The researchers hypothesize that patients will likely not take their medication unless they perceive it as absolutely necessary, instead of taking the medicine because they are scheduled to do so.

“Attempts to increase necessity beliefs about medication in RA patients might be worthwhile in improving medication adherence,” the researchers concluded, while noting that future research in this field is needed to determine the effectiveness of the interventions. “However, strong evidence about effective interventions to increase necessity beliefs about medication is currently absent.”