Background/Purpose:  Over the last two decades, survey and observational studies of drug-related consultations have consistently shown a lack of adequate medication related discussions between patients and providers. The purpose of this study is to describe medication-related discussions between patients and rheumatologists concerning prescription of a new DMARD. We specifically address whether patient-provider discussions cover clinical guideline recommendations for DMARD communication, including discussion of medication side effects, treatment options, etc.

Methods:  This observational study includes data from clinic visits of 38 RA patients (3 rheumatologists) that occurred in a southeastern state from May 2014 to December 2015. Patients were eligible if they were prescribed a new or different DMARD (never prescribed before) at their rheumatology appointment. Clinic visits were audio recorded and medication-related segments transcribed verbatim. Transcripts were coded to measure aspects of the following 15 DMARD topics concerning the DMARD prescribed during the clinic visit: dosage, how to take (e.g., with food), frequency, timing, duration, types of negative side effects, side effect severity, contraindications, long-term effectiveness, drug interactions, mechanism of action, cost, length of time until medication works, medication benefits, and strategies to reduce or monitor risk. Descriptive statistics were calculated using SPSS.

Results:  Approximately one third of patients (32%; n=12) had never taken a DMARD. The number of DMARDs rheumatologists discussed with patients ranged from one to seven (M=1.82, SD=1.40). The number of prescribed DMARD-related topics ranged from 7 to 14 (M=11.03, SD=1.73). No clinic visit addressed all 15 topics and rheumatologists initiated 88% of the topics. Patients initiated the most discussions related to the following topics: drug interactions (62%), long-term effectiveness (43%), and length of time until medication works (19%). Topics that were covered most often included types of negative side effects (100%) and strategies to reduce or monitor risk (97%). Cost was not covered in about one third (34%) of clinic visits – yet, cost was one of the top three topics for which patients (40%) asked the most question, the other two being drug interactions (67%) and types of negative side effects (42%). Rheumatologists discussed an average of 4.6 negative side effects (SD = 2.7, range 1-16). The majority of patients 84% (n=32) did not express concern about any side-effects.

Conclusion:  Our findings counter other studies showing patient-provider medication-related discussions lack breadth and results show that DMARD topics covered during RA patient-rheumatologist encounters address many guideline recommended topics. Findings highlight areas of strength as well as areas for improvement regarding patient-provider medication-related discussion.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/how-rheumatoid-arthritis-patients-and-rheumatologists-communicate-during-clinic-visits-when-a-new-dmard-is-prescribed/