FRI0696 Patient activation and adherence to biological therapy: preliminary results

Abstract

Background: Medication non-adherence is associated with treatment failure. Some authors show a positive relationship between patient activation and both, adherence to treatment for chronic conditions and improved outcomes. Objectives: To present preliminary results of a study measuring adherence to biological therapy and its relationship with the Patient Activation Measure (PAM) in the outpatient setting. Methods: Ambispective longitudinal observational descriptive study in a general tertiary university hospital. Patients on treatment with the same biological drug for ≥6 months were included in order of arrival. Patients with some degree of mental disability, which prevented understanding of the purpose and parameters of the study, were excluded. Demographic variables (sex, age, environment, educational level), diagnosis and treatment were collected. To measure adherence, the Simplified Medication Adherence Questionnaire (SMAQ), validated in Spain, and the medication possession ratio (MPR) were used. Patients were considered as non-adherent if MPR<80% and/ or non-adherent SMAQ. To measure patient's ability to play an active role in their health care, PAM questionnaire, consisting on 13 items and validated in Spain, was used. It sorts patients into 4 activation levels, which were grouped together into not activated (PAM 1-2) or activated (PAM 3-4). Relationship between adherence to treatment, as a combined variable, and PAM was analyzed using chi-square, considering significance level p<0,05. Statistical analysis were performed with spss v17.0. Results: Fifty patients (58% women) were included. Mean age: 48 years (95% CI: 33 to 63); 92% lived in urban areas, 28% completed elementary education, 44% high-school and 28% university studies. Diagnosis: rheumatoid arthritis (38%), Crohn's disease (20%), psoriasis (20%), ankylosing spondylitis (16%) and psoriatic arthritis (6%). Treatment: adalimumab (44%), etanercept (16%), tocilizumab (16%), secukinumab (12%), ustekinumab (6%), golimumab (4%) and ixekizumab (2%). Median time on the biological drug treatment: 26 months (IQR 53). PAM level: 2, 16, 54 and 28% for levels 1,2,3 and 4, respectively. The proportion of adherent patients was 47% (23/49), being higher (50%) among the activated patients compared to the non-activated patients (33%), even though the differences were not statistically significant. Conclusions: Among biologic treated patients, 82% show a high degree of activation on their disease and treatment self-management. However, only 47% were adherent to treatment, when combining the SMAQ questionnaire and the medication possession ratio quantification. The greater proportion of adherence found among patients with a higher degree of activation could indicate a positive relationship between activation and adherence, so analyzing and promoting patient activation seems important in order to improve adherence to biologic drugs.