PsA: Identifying Drivers of Noncompliance


A brief overview on the drivers of noncompliance and treatment adherence in patients with psoriatic arthritis.


Michele M. Cerra, MSN, FNP-C: What are some of the reasons for low rates of treatment compliance in our patients? We’ve touched on a few already. What are you seeing in your practice in your area as far as compliance to treatment and barriers to that?

Nancy Eisenberger, MSN, FNP-C: Some of the barriers have to do with denial as I said earlier. They can’t accept their diseases yet. Other times it’s my younger people. They don’t want to be different. Why do I need medicine? Why do I have to give myself the injection? Why do I have to get an infusion or take these pills? Until they get bad enough where they have x-ray changes, or it’s getting in the way of their activities of daily living, that’s when we can see it. It’s interesting. I like to get my patients in for infusions often because I know they’re staying adherent to their medications and I have routine with patients who are afraid of treatment. I take them for a tour of the infusion suite. They happen to see it’s not the worst place in the world. There [are] people of all ages. We have 6 offices and all of them have infusion. They see there’s at least 10 people sitting in a room and laughing and not feeling ill from medication, so that’s something that I find helps with patients that you’re concerned if they’re going to be adherent or not to their medication.

Michele M. Cerra, MSN, FNP-C: I agree with the compliance as far as IV [intravenous] infusion. We know our patients. You see the personality type or they’re afraid. They’re needle phobic and they don’t want to give themselves an injection, or they liked this about taking their methotrexate. They take few holidays, they’re traveling, or in our patients who are trying to get pregnant. But I agree. I take them over to our infusion suite. We have 1 at each of our clinics and if 1 room is empty, I take them in. They could watch TV, a nice comfortable recliner, tell them you know the nurses here very well. I try to introduce them. It gives them reassurance and they see other patients as they’re walking by who are getting infusions it helps as far as keeping them on drug. Also, with disease state awareness it’s important. I use up to date ACR [American College of Rheumatology] handouts. I have them all in my room and patients while they’re waiting for me can start reading. I also have some posters I like to put in my room with psoriatic arthritis [PsA] and it has a picture of a female and all the different areas of her body that can be affected. I say to them each time you come in I want you to look at that and if you think you’re having some symptom, maybe it’s in the gut or in your eye or in your spine, I need to know about that so we can manage it and you can feel better and continue to have a good quality of life and no problems sleeping and going to do your job and being with your family.

Transcript edited for clarity.

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