Background/Purpose: The RhMAT is a medication assessment tool developed to specifically analyse pharmacotherapy adherence to evidence based medicine and guidelines on the management of rheumatoid arthritis. The RhMAT was developed to identify any gaps within management care plans. The objective of this study was to implement the innovative RhMAT within a pharmaceutical care plan model for rheumatoid arthritis patients.

Methods: Rheumatoid arthritis patients regularly attending the rheumatology clinic at Mater Dei Hospital who were 18 years or older, able to understand Maltese or English were eligible to participate in the study. The University of Malta Ethics approval and the patients’ consent was obtained. The study was run between January and December 2014.  The patients’ medical notes were screened. Patient interviews were conducted where necessary to fill in gaps in the documentation. The RhMAT was completed for the patients taking part in the study.  For each criterion given in the RhMAT the researcher can choose one of four options between adherence (yes), non adherence no justified, non adherence not justified, not applicable and insufficient data (table 1).  The RhMAT adherence rate achieved was calculated. A score of 50% or less was determined as low adherence, a score between 51% and 74% showed intermediate adherence and a score of 75% or more was determined as high adherence to the RhMAT.

Results: A total of 78 patients (56 females, 22 males) were recruited for the study.  More than half of the patients (55% n=43) were prescribed a traditional disease modifying antirheumatic drug (tDMARD) with 81% (n=35) being on monotherapy tDMARD. Methotrexate was the most commonly prescribed tDMARD whether monotherapy or in combination with other tDMARDs (n=29, 67%). Overall, a score of 75% or more, determined as high adherence rate, was achieved in 80% (n=62) and a score 51% to 74% or intermediate adherence rate was achieved in 19% (n=15). A low adherence score was achieved only in 1 patient.The mean score for the methotrexate section was 99.5% (n=54). The  mean score for the biologic section was 97.9% (n=35).  Time taken to complete each RhMAT for each patient was 15 minutes. 

Conclusion: Methotrexate was the most common tDMARD prescribed. The average time taken to complete each RhMAT was realistic,practical and feasible for a busy clinic. The overall high adherence rate achieved indicates that the majority of the current pharmacotherapy of the study patient population is in agreement with established guidelines. A  high adherence rate was also observed with respect to methotexte prescribing and monitoring and screening for biologic drugs. The RhMAT was useful in identifiying gaps in agreement to established guidelines thereby enabling the clinical pharmacist to discuss these issues with the clinicians further improving the quality of service offered.

Table 1.  Extract from the RhMAT – Methotrexate section

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/implementation-in-clinical-practice-of-a-medication-assessment-tool-specific-for-rheumatoid-arthritis-rhmat/