Demographic Factors Influence Medicine Adherence, Satisfaction for RA Treatment

Elizabeth Salt, PhD

Credit: University of Kentucky, College of Nursing

A new study on patients with rheumatoid arthritis (RA) underscores the critical role of psychosocial, clinical, and demographic factors and patient-provider relationships in medication adherence and satisfaction.

“This study contributes to the understanding of factors likely contributing to health disparities,” wrote investigators, led by Elizabeth Salt, PhD, from the University of Kentucky.

RA affects 18 million people worldwide, and it is recommended to begin disease-modifying anti-rheumatic drugs within 3 months of diagnosis to prevent joint destruction, loss of joint function, and pain, all of which can happen with untreated synovitis. Unfortunately, only 40% of patients do not have medication adherence.

Factors such as age, gender, comorbidities, medication use, and disease status affect medication adherence in patients with RA. Studies also suggest other factors that may affect medication adherence include trust in the provider, knowledge about RA and RA medications, medication adverse events, and the quality of patient-provider communication.

The observational study assessed the relationship between psychosocial, clinical, and demographic factors with medication adherence, patient satisfaction, and medication intolerance.

Psychosocial, Clinical, and Demographic factors

• Psychosocial factors: Anxiety, trust in the provider, quality of patient-provider communication, fatigue, RA knowledge, adverse medication events
• Clinical factors: Disease activity, RA medications, RA duration
• Demographic factors: Age and gender.

The team also aimed to identify the psychosocial, clinical, and demographic factors that could predict medication adherence, patient satisfaction, and medication intolerance among RA patients.

The study included a sample of 155 RA patients who were ≥ 18 years old. The mean age was 55.3 years. Most were female (84%), and a large percentage of the sample were non-Hispanic White (86%). Less than half (45%) had been diagnosed with RA in the last 10 years.

They had an RA diagnosis based on the 2010 American College of Rheumatology Diagnostic Criteria. At baseline, they self-reported a questionnaire addressing 13 measures:

• Medication Adherence (Medication Adherence Report Scale-9RA)
• Patient satisfaction (Client Satisfaction Questionnaire-8)
• Medication Intolerance (Patient-Perceived Methotrexate Intolerance Scale)
• Patient knowledge about RA medications and care
• Medication adverse events
• Trust in the provider (Trust in the Physician Scale)
• Quality of patient-provider communication (Patient-health Care Provider Communication Scale
• Pain intensity (1 item on the 29-item PROMIS short form)
• Pain interference (4 items of the 29-item PROMIS short form)
• Anxiety (4 items of the 29-item PROMIS short form)
• Fatigue (4 items of the 29-item PROMIS short form)
• Disease activity (Routine Assessment of Patient Index Data 3)
• Clinical and demographic data (self-reporting RA duration)

Salt and colleagues analyzed the relationships by using correlation analysis, linear regression, and cluster analysis to detect patient subgroups with determination decisions based on Schwartz’s Bayesian Criterion.

Investigators found non-Hispanic White participants have a greater medication adherence (P = .028) and greater trust in their healthcare provider. They were linked to lower disease activity and pain intensity.

Patients diagnosed more recently had greater patient satisfaction (P = .050). The team saw patient satisfaction increased when lower disease activity, pain intensity, interference, fatigue, and anxiety decreased (each P < .01). Conversely, patient satisfaction had a positive association with RA knowledge, trust in the provider, and quality of patient-provider communication (each P < .02).

Investigators found medication tolerance varied depending on the disease duration, and tolerance was positively associated with disease activity, pain interference, and fatigue.

Compared to Cluster 2, participants in Cluster 1 had greater medication adherence, patient satisfaction, lower medication intolerance, more knowledge about RA, greater trust in their provider, and perceived quality of patient-provider communication.

The team highlighted 3 limitations: the study was only conducted at 1 university health care system, PPMIS is a new measure needing further validation, and the study lacked consideration about beliefs regarding medication and how it may relate to medication adherence.

“This study identified a unique phenotype of patients disproportionately affected by social determinants of health and adversely affected by poor RA health outcomes,” investigators concluded. “It is imperative that multilevel interventions tailored for those most impacted by social determinants of health be developed to improve the identified disparities in RA outcomes.”

References

^{Salt E, Wiggins AT, Francis D, Lohr K, Rayens MK. Patient trust, quality communication, and medication adherence in rheumatoid arthritis patients highly affected by social determinants of health. Musculoskeletal Care. 2024;22(2):e1882. doi:10.1002/msc.1882}