Session Information
Date: Monday, November 9, 2015
Title: Quality Measures and Quality of Care Poster Session (ARHP): Clinical Practice/Patient Care
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Poor
adherence to medications is a common problem among rheumatology patients that can
lead to irreversible negative outcomes. We piloted an intervention using
patient navigators- laypeople trained in care coordination, basic rheumatology,
and relevant pharmacology- to improve adherence to oral disease-modifying
antirheumatic drugs (DMARDs). Navigators aimed to identify and
understand barriers to adherence to DMARDs that may be missed during clinical
encounters and to work with patients to develop personalized strategies to
overcome these barriers.
Methods: We
recruited patients ≥18 years old from a large academic Arthritis Center. Eligibility
included a rheumatic disease diagnosis by a board certified rheumatologist and initiation
of an oral DMARD within the prior 6 months. Navigators conducted baseline
interviews to assess patients’ understanding of their rheumatic disease and their
adherence to DMARDs. Then, depending on need, navigators contacted patients once
every 1-4 weeks by phone or in person, and these conversations were thoroughly documented.
Navigators connected patients with hospital resources, provided education about
diagnoses and medications, and developed individually tailored strategies to
circumvent barriers. Five team members independently reviewed the documentation
from patient call notes to categorize issues raised by participants and
subsequent navigator actions. Multiple issues and actions could be recorded per
patient but each was counted only one time per patient. Differences in coding
were adjudicated by the team.
Results: Two
navigators followed 88 patients for up to six months. Mean age was 54 years (SD
17) and 92% were female. 81% had inflammatory arthritis, 10% had lupus or mixed
connective tissue disease, and 9% had other rheumatic diseases. Seven main categories
of patient issues relevant to adherence were identified: adverse events (45%), challenges
with medication acquisition (31%), concerns about medication effectiveness
(30%), lack of knowledge about medications or diagnosis (20%), need for social
support (14%), financial/insurance difficulties (11%), and interruptions in
medication use (9%) (Table). 19% of patients raised no issues, 25%
discussed one, and 56% ≥ 2 issues. The most common navigator actions included:
facilitation of patient-doctor communication (33%), medication and diagnosis
education (30%), development of individualized strategies to improve adherence
(18%), and assistance with financial/insurance issues (11%) (Table).
Conclusion: Most
patients described one or more issues related to their oral DMARD adherence or to
their rheumatic disease. Navigators played a key role uncovering and addressing
concerns not identified by routine clinical care. Further analyses will assess the
impact of navigators on DMARD adherence and rheumatic disease-related outcomes.
|
Table. Patient issues and navigator actions related to medication adherence (N= 88) |
|
|
Categories of Patient Issues |
N (%) |
|
Adverse events (e.g. alopecia, rash, gastrointestinal side effects) |
40 (45%) |
|
Challenges with medication acquisition (e.g. refills and prior authorizations) |
27 (31%) |
|
Concerns about medication effectiveness (e.g. onset of action) |
26 (30%) |
|
Lack of knowledge about medications or diagnosis |
18 (20%) |
|
Need for social support (e.g. expression of depressive symptoms) |
12 (14%) |
|
Financial/Insurance difficulties obtaining medications (e.g. high co-payments, billing errors) |
10 (11%) |
|
Interruptions in medication use (e.g. surgery, infections) |
8 (9%) |
|
Navigator Actions |
N (%) |
|
Facilitation of patient-doctor communication (e.g. notified rheumatologists of patients symptoms or concerns) |
29 (33%) |
|
Medication or diagnosis education (e.g. explained side effects, described expected timing of medication effects, helped manage side effects) |
26 (30%) |
|
Development of individualized strategies to improve adherence (e.g. pillboxes, text messages, set-up of automatic refills, magnet reminders) |
16 (18%) |
|
Assistance with financial and insurance issues (e.g. referral to financial counselor, interactions with insurance companies) |
10 (11%) |
|
Coordination of care (e.g. helped patients obtain referrals to other specialties) |
8 (9%) |
|
Provision of social and emotional support |
7 (8%) |
|
Facilitation of expedited mental health referrals |
6 (7%) |
To cite this abstract in AMA style:
Campos A, Wohlfahrt A, Lo Y, Iversen MD, Massarotti E, Solomon DH, Feldman CH. Uncovering and Addressing Issues Related to Medication Adherence Among Patients with Rheumatic Diseases: A Patient Navigator Pilot Program [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/uncovering-and-addressing-issues-related-to-medication-adherence-among-patients-with-rheumatic-diseases-a-patient-navigator-pilot-program/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/uncovering-and-addressing-issues-related-to-medication-adherence-among-patients-with-rheumatic-diseases-a-patient-navigator-pilot-program/