Session Information
Date: Sunday, November 13, 2016
Title: Rheumatoid Arthritis – Clinical Aspects - Poster I: Clinical Characteristics/Presentation/Prognosis
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose:
Disease activity and fatigue are key endpoints to evaluate the outcome of treatment for rheumatoid arthritis (RA). Among factors that may contribute to good outcome are adherence (i.e., the extent to which patients’ behaviors corresponds with agreed recommendations from their doctor) and health literacy (patients’ understanding and use of health information).
Methods:
The survey included a representative, nationwide sample of German physicians specialized in rheumatology+ and patients with RA. The physician questionnaire included the disease activity score (DAS28) and medical prescriptions. The patient questionnaire included fatigue (EORTC QLQ-FA13) health education literacy (HELP), and patients’ listings of their medications.
Adherence was operationalized in various ways: patient-reported (CQR5), behavioral (correspondence between physicians and patients listings of medications), physician-assessed (five-point rating scale ranging from 1=very adherent to 5=not at all adherent) and a combined measure of physician rating (1= very adherent, 0 = less adherent) and the match between physicians’ prescriptions and patients’ accounts of their medications (1 = perfect match, 0 = no perfect match), leading to three categories of adherence: high, medium and low. Linear regressions were calculated using DAS28 and Physical Fatigue as dependent variables and adherence, health literacy and the set of demographic and clinical variables as predictor variables.
Results:
A total of 708 pairs of patient and physician questionnaires were analyzed. The mean age of the patients, of whom 73% were women, was 60 years (SD=12). At the time of assessment, 67% of the patients showed low disease activity (DAS28 < 3.2), 26% moderate disease activity (DAS28 3.2 to 5.1), and 4% high disease activity (DAS28 > 5.1).
|
DAS |
Physical Fatigue |
|||||
| Predictor |
B (95%-CI) |
p-value |
R² |
B (95%-CI) |
p-value |
R² |
| CQR5 |
-.025 (-.164; .113) |
.720 |
.000 |
.064 (-.035; .163) |
.205 |
.002 |
| Medication match doctor vs patient in % |
-.003 (-.006; .001) |
.120 |
.004 |
.001 (-.002; .003) |
.668 |
.000 |
| MTX, non-MTX-DMARDS, glucocorticoids and biologicals, all taken as prescribed |
-.237 (-.456; -.019 |
.033 |
.007 |
-.063 (-.218; .092) |
.426 |
.001 |
| Adherence by doctor (ref. medium or less adherence) |
|
|
|
|
|
|
| adherent |
-.359 (-.668; -.051) |
.022 |
.044 |
-.105 (-.330; .120) |
.359 |
.012 |
| very adherent |
-.741 (-1.043; -.439) |
<.001 |
-.265 (-.485; -.045) |
.018 |
||
| Adherence composite score (ref. low adherence) |
|
|
|
|
|
|
| medium adherence |
-.266 (-.476; -.056) |
.013 |
.034 |
-.082 (-.231; .068) |
.284 |
.016 |
| high adherence |
-.579 (-.814; -.344) |
<.001 |
-.277 (-.445; -.110) |
.001 |
||
| HELP Capability of application of information |
.428 (.300; .556) |
<.001 |
.062 |
.350 (.260; .440) |
<.001 |
.080 |
| HELP Capability of understanding of medical information |
.251 (.146; .357) |
<.001 |
.033 |
.217 (.144; .290) |
<.001 |
.049 |
| HELP Communication capability |
.249 (.122; .375) |
<.001 |
.022 |
.328 (.243; .413) |
<.001 |
.079 |
| B, regression coefficient; 95%-CI, 95%- confidence interval, R², coefficient of determination | ||||||
Multiple regression analyses show, that adherence by doctor (p = .000 and p = .034) as well as the adherence composite score (p = .000 and p = .001) are independent predictors as well as health literacy (p = .000) for DAS and Physical Fatigue when controlling for age, sex, smoking, drinking, sport.
Conclusion:
This study showed that DAS and Physical Fatigue were related to adherence and health literacy. This finding highlights the importance of patient education and counseling in order to increase both, medical understanding and adherence to therapy.
To cite this abstract in AMA style:
Kuipers JG, Koller M, Zeman F, Mueller K, Rueffer U. Disease Activity and Physical Fatigue As Related to Adherence and Health Literacy in Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/disease-activity-and-physical-fatigue-as-related-to-adherence-and-health-literacy-in-patients-with-rheumatoid-arthritis/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/disease-activity-and-physical-fatigue-as-related-to-adherence-and-health-literacy-in-patients-with-rheumatoid-arthritis/