Background/Purpose: In 2004 we initiated a cohort of rheumatoid arthritis (RA) patients with recent-onset disease. From 2008 onwards, both construct of compliance, persistence on therapy (P) and adherence with therapy (A) were prospectively assessed through a questionnaire (the CQ) that additionally investigated motivations for non-P, and a visual analogue scale for C (C-VAS). We hypothesized that how a patient subjectively attributed a motivation (patient-dependent vs. patient independent) impacted his/her evaluation of C. Objectives were to examine the correlation between compliance assessed as per the CQ and per the VAS, and to investigate if the selection of patient-independent motivation for non-P predicted better score of C.

Methods: Up to January 2016, the cohort comprised 180 patients with variable follow-up. Since 2008, CQ and C-VAS were concomitantly applied at regular six-months apart-intervals. The CQ is a 22-items questionnaire, where item 11 investigates 15 predefined patient´s motivations for non-P and one open answer; a patient is considered CQ-compliant if A and P. The C-VAS is a 100 mm VAS, where 0 indicates “very good compliance”. Each motivation for non-P was classified as patient-dependent or patient-independent by 50 patients randomly selected and directly interviewed to such purpose (≥70% agreement among the patients interviewed). Multiple regression analysis was used to evaluate patient-independent motivation as a predictor of better compliance. The study was approved by the institution’s internal review board. Written informed consent was obtained.

Results: The final number of patients for which data were analyzed was 160. At inclusion in the cohort, patients were primarily middle-age female (90%), with 5.4±2.6 months of disease duration and high disease activity. The majority had RF (85.6%) and antibodies to cyclic citrullinated peptides (88.1%). To January 2016, the (mean±SD) length of follow-up was 6.7±3.4 years, during which patients completed 1516 pairs of CQ and C-VAS. The C-VAS significantly correlated with the CQ, r=0.468, p=0.001. Cut-off value of C-VAS to predict CQ-compliance was 7.5 mm. During follow-up, there 670 CQs scored as with non-P among whom, 654 had at least one motivation for non-P selected; of them, 549 CQs (70.2%) corresponded to non-P patients who selected only patient-independent motivations and 31 (4.7%) to those who selected only patient-dependent motivations. Patients from the former group had better C-VAS scores than their counterparts. The selection of exclusively independent motivations for non-P predicted C-VAS score and CQ score, ß: -0.15, 95%CI: -19.2 to -6.8, p≤0.001 and ß: 0.79, 95%CI: 0.01-0.819, p=0.045, respectively. Also, the selection of exclusively independent motivations for non-P predicted VAS-compliance (OR: 15.6, 95%CI: 5.4-45.3, p≤0.001) and CQ-compliance (OR: 2.25, 95%CI: 1.062-4.664, p=0.034).

Conclusion: Patient´s motivations for non-P impact how they perceived and scored their compliance; a potential consequence of such behavior is that non-compliant patients may be misidentified.

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/patients-motivations-for-non-persistence-with-medication-impact-how-they-score-compliance/