Session Information
Date: Sunday, November 13, 2016
Title: Rheumatoid Arthritis – Clinical Aspects - ARHP Poster
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Patient misunderstandings about DMARDs may contribute to nonadherence. We present longitudinal observational data regarding whether patients can accurately recall medication information about a newly-prescribed DMARD immediately after a rheumatology office visit and whether this is associated with DMARD prescription filling behavior one week after the office visit.
Methods: We recruited a convenience sample of 38 adult English-speaking RA patients who were prescribed a new self-administered DMARD from one rheumatology clinic in a southeastern state. The office visit during which the new DMARD was prescribed was audiotape recorded. Immediately after this visit, patients completed a demographic survey and were asked to recall what their rheumatologist said about how to take the DMARD and its benefits, side effects, and risks. Office visits and patient interviews were transcribed verbatim. Two independent coders who were blinded to study hypotheses compared what the rheumatologist said during the office visit to what the patient recalled for 15 different medication topics (Table 1). Coders recorded whether the rheumatologist discussed this topic during the visit and whether the patient’s recall of what the rheumatologist said was accurate (yes/no). Inter-reliability for the 15 topics was 0.89. We calculated descriptive statistics and examined bivariate associations to determine correlates of the patient inaccurately recalling (yes/no) any medication information (α=0.05).
Results: Participants were primarily women (87%) and white (71%). The mean age and disease duration were 49.1 (SD=13.4) and 9.4 years (SD=9.4), respectively. Only 12 (20%) patients were receiving a DMARD prescription for the first time. Nineteen patients (50%) inaccurately recalled information about at least one medication topic immediately after their office visit. Table 1 presents our study results. Patients with inaccurate recall had a longer disease duration (t(36)=-3.4, p=0.02), lower health literacy (χ2=7.1; p<0.01), and a lower household income (<$25,000 annually) (χ2=4.5; p=0.03). Patients with inaccurate recall were not less likely to get their prescription filled at 1-week follow-up (χ2=2.6; p=0.11).
Conclusion: Half of patients inaccurately recalled medication information about a newly-prescribed DMARD immediately after their rheumatology office visit. A number of DMARD topics were not explicitly discussed during the office visit, but may have been discussed in previous visits. Patients with low health literacy, lower household income, and longer disease duration were more likely to inaccurately recall DMARD information.
Table 1: Characteristics of rheumatology office visits during which a new DMARD was prescribed
| Topic | Rheumatologist Did Not Discuss Topic During Office Visit N (%) | Patient Did Not Accurately Recall Information About Topic N (%) | Examples of Inaccurate Recall |
| Long-term effectiveness of DMARD | 30(79%) | 0 | – |
| How long patient should take DMARD (duration) | 19(50%) | 0 | – |
| DMARD-other drug interactions | 16(42%) | 0 | – |
| Contraindications | 16(42%) | 0 | – |
| Costs of DMARD | 12(32%) | 0 | – |
| Time until DMARD begins to take effect | 11(29%) | 2(5%) | Patient said it might take two weeks to see improvement when doctor said three months. |
| Timing to take DMARD | 8(21%) | 1(3%) | Patient said medication should be taken in afternoon when doctor said night. |
| Dosage | 8(21%) | 1(3%) | |
| Severity of side effects | 7(18%) | 0 | – |
| Mechanism of action | 6(16%) | 2(5%) | Patient said medication would stop cells from eating the bone in their body when doctor said it would reduce inflammation. |
| How to take DMARD | 3(8%) | 2(5%) | Patient said doctor didn’t say how medication was supposed to be taken when doctor said it should be taken orally. |
| How often to take DMARD (frequency) | 1(3%) | 2(5%) | |
| Benefits of DMARD | 1(3%) | 10(26%) | Patient lists benefits of medication that were not discussed by doctor. |
| Side effect risk reduction strategies | 1(3%) | 5(13%) | Patient mentions having to engage in risk reduction strategies that were not recommended by doctor. |
| Side effects of DMARD | 0 | 5(13%) | Patient lists kidney damage as side effect of medication when doctor did not mention kidney damage as side effect. |
To cite this abstract in AMA style:
Carpenter D, Geryk L, Roberts C, Jonas BL, Blalock SJ. Rheumatoid Arthritis Patients’ Ability to Accurately Recall DMARD Information Immediately Following an Office Visit with Their Rheumatologist [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/rheumatoid-arthritis-patients-ability-to-accurately-recall-dmard-information-immediately-following-an-office-visit-with-their-rheumatologist/. Accessed .ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatoid-arthritis-patients-ability-to-accurately-recall-dmard-information-immediately-following-an-office-visit-with-their-rheumatologist/