FRI0635 Medication adherence in patients with rheumatic diseases: a qualitative study in a biologics clinic

Abstract

Background: High rates of non-adherence to prescribed medications in rheumatic diseases have been reported, with adherence as low as 30% in some studies [1, 2]. Physicians commonly overestimate adherence [3]. Consequences of non-adherence include poorer patient outcomes and increased healthcare costs [1, 2]. Improving adherence may be as effective as developments in biomedical management in terms of positive health outcomes [4]. Understanding factors contributing to non-adherence may inform strategies for improvement. Objectives: This study aims to explore factors affecting medication adherence in patients attending a dedicated biologics clinic. Methods: Patients were selected by purposive sampling. Semi-structured interviews were performed and continued until data saturation was achieved in order to examine reasons why patients failed to take their prescribed medication. Interviews were transcribed and coded using NVIVO. The principles of grounded theory were used to analyse the data. The emergent themes were informed by health behaviour theories and factors which have previously correlated with adherence in similar cohorts. Results: Major themes which emerged include the concept that the presence of active symptoms significantly influenced adherence. It was noted that patients tended not to prioritise medication taking until they had recurrence of symptoms. Patients sometimes failed to display an understanding of the concept of disease activity, or concern for the risk of long term joint damage or other consequences of uncontrolled inflammation. They also expressed concern regarding potential longterm side effects of biologic medications; even if they had not experienced any side effects to date. Methotrexate was perceived as a toxic and 'heavy' medication. Biologics were described by patients as 'life-changing' and superior to conventional DMARDs. Patients identified their relationship with their rheumatologist as being pivotal in their experience of their condition and medication management. Diet, exercise and stress were perceived to play a critical role in disease causation, flares and treatment. Several minor themes were identified. Developing habitual patterned behaviour was a challenge for some participants. Affordability was an issue despite biologics being heavily subsidised. Depression, social situation and needle phobia were potential barriers to adherence. Preference for alternative therapy, distrust of 'synthetic medications' and an awareness of the high cost of biologics affected decision making for some patients. Conclusions: This study examined the medication adherence of a group of patients with rheumatic diseases who are very closely managed in a dedicated biologics clinic. Even in this group of patients, factors which contribute to medication non-adherence were readily identified. Several of these themes suggest that enhancing patient education may improve adherence in this group.