Background/Purpose: Injectable
biologic medications have become part of the routine treatment rheumatoid
arthritis (RA), and other inflammatory arthritides. These
medications are associated with potentially serious
risks. Patients must receive adequate education on disease states,
medication administration, common and side effects, and when to contact a
health care professional with problems. Aim: Examine
the sources from which information concerning biological drug safety is
obtained by patients. Identify specific knowledge gaps concerning biologic drug
administration and crucial aspects of safety

Methods: Surveys
were administered to a random group of patients receiving injectable
biological therapies and seen at 2 different clinical settings. We captured
basic demographics, disease characteristics, and current and past biologics
used. We assessed the type, and method of education received regarding drugs
and disease, satisfaction with education, and the level of retained medical
knowledge concerning critical aspects of injectable biologics. Questions
covered injection technique, storage and handling, side effects, signs of
infection, and what to do for elective surgery.  Questions were asked
using Visual Analog Scales (VAS), Likert scales, with additional comments recorded.
Frequencies were compared using Chi-square (X²) tests.  We
calculated odds ratios of satisfactory medication safety knowledge (answered
all questions correctly) using logistic regression adjusted for demographics
(age, sex, race). 

Results: Table
1.  Participants correctly identified appropriate
injection sites, technique, and storage and handling of biologics 100% of the
time.  There was considerable variability in knowledge concerning basic
aspects of relevance to biologic safety.  Among the overall group 30% were
unable to correctly answer all 4 knowledge questions concerning biologic safety
issues related to infections, elective surgery, and when to contact the
rheumatologist.   Level of education (≤HS vs >HS) was not
associated with medication safety knowledge (X² 1.05, p=0.31).
Patients who had received their education from a nurse were more likely to
answer all questions correctly (X² 8.20, p<0.01).  Safety
knowledge was significantly associated with receiving biologic education from a
nurse (OR 8.9, 95%CI 1.9, 42.4, p=0.006) after adjustment for demographic
characteristics.

Conclusion: Critical
gaps in knowledge exist regarding safe use of biologics. HCPs bear
responsibility for educating patients about the safety aspects of biologic
medications. In this small study, education provided by a nurse was associated
with greater knowledge by patients.  Further study is needed to identify
the optimal methods of delivering patient education that will be applicable
across care settings and to develop a standardized patient curriculum.

Table 1