Background/Purpose:

Medication adherence in Rheumatoid Arthritis (RA) is reported to be generally low. This major problem needs to be addressed because it leads to reduced treatment benefits and greater healthcare costs. We hypothesized that specific medication beliefs would influence adherence to disease-modifying anti-rheumatic drugs (DMARDs) in RA patients, and assessed this in a cross-sectional study.

Methods:

Based on focus groups and a quantitative survey, we identified 5 belief factors in patients with RA: that DMARDs harm health; that DMARDs benefit health; that DMARD dosing/regimens can be changed by patients; that DMARD side effects can be effectively managed; that DMARD side effects cannot be effectively managed. In this IRB approved study, we administered a Medication Behavior Survey (n=21, developed from focus group data) assessing these 5 belief factors and the 8-item Morisky Medication Adherence Scale (MMAS-8, score range 0-8.0) to measure non-adherence in a consecutive sample of English-speaking RA patients during routine outpatient visits from November 2012 to April 2013 at our tertiary referral center. Multiple linear regression (MLR) was used to examine the relationship between the 5 belief factors and MMAS-8, as well as MMAS-8 intentional and unintentional non-adherence subsets, adjusting for demographic factors (gender, race, age and education).

Results:

Among 279 English-speaking RA patients (82% females; 56% Chinese, 15% Malays, 22% Indians; mean age (SD) 53.8 (12.7) years). MLR with MMAS-8 scores showed that a stronger belief that DMARD dosing/regimens can be changed by patients was significantly negatively correlated with MMAS-8 scores (beta=-0.53, 95% CI -0.75 to -0.37, p<0.001) in a model that also included the other 4 factors (none of which was significantly associated with MMAS-8 scores). Similarly, MLR with MMAS-8 subsets showed that a stronger belief that DMARD dosing/regimens can be changed by patients was negatively correlated with both intentional and unintentional non-adherence MMAS-8 subsets (beta=-0.25, 95% CI -0.39 to -0.11, p<0.001; beta=-0.28, 95% CI -0.42 to -0.14, p<0.001, respectively). Additionally, belief that DMARDs side effects cannot be effectively managed was negatively associated with intentional non-adherence MMAS-8 subset (beta = -0.18, 95% CI -0.32 to -0.03, p=0.019).

Conclusion:

We found that stronger belief that DMARD dosing/regimens can be changed by patients was an important factor associated with non-adherence in an urban Asian population. Other beliefs do not apparently provide additional value in accounting for non-adherence. If confirmed in prospective studies, this observation may provide a simple and rapid way to identify patients who are more likely to be non-adherent with DMARD therapy.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/belief-in-self-adjustability-of-medication-dosing-is-negatively-correlated-with-medication-adherence-in-patients-with-rheumatoid-arthritis/