11 September 2019

Why rheumatic patients stop taking their meds

Pharmaceuticals Rheumatology

Trust in their treating doctor is a major factor for patients with rheumatic conditions to continue taking their long-term medications, researchers say.

An Australian study, recently published in Arthritis Care and Researchfound that patients with gout, osteoporosis and rheumatoid arthritis were more likely to continue to take their medication when they had a strong relationship with their GP or specialist.

The qualitative study analysed responses from 67 patients from five rheumatology clinics. The patients had a confirmed diagnosis of gout, osteoporosis, rheumatoid arthritis, and 20% had a comorbid diagnosis. Fifteen carers were also included in the study.

Participants were asked to identify factors considered important for medication adherence and then rank them according to level of importance. The research team then thematically organised the responses and calculated their frequency using an importance score (scale 0-1).

The most common self-reported factors affecting adherence was trust in doctor (importance score 0.46), medication effectiveness (0.31), doctor’s knowledge (0.25), side-effects (0.23) and medication taking routine (0.13).

Some patients said the idea of being on life-long medication was daunting, particularly if they were younger or aware of some drug side-effects, such as liver toxicity with methotrexate.

“There are side-effects that maybe you only see after 40 years, but the drug has been in the market for five, so you have to wait to see what happens,” said one study participant, a caregiver to her husband with rheumatoid arthritis.

But this feeling of being a “guinea pig” trialling relatively new life-long drugs could be overcome when a patient was able to talk to their doctor about their concerns.

The study authors found there was a 19% higher risk of non-adherence among patients whose doctors communicated poorly compared with those whose doctors who communicated well.

Other factors reported to influence adherence included the patient’s understanding of their medications and if they could easily take the medicine as part of their existing daily routine.

Sometimes, relatively minor factors were the reason for failure to take the prescribed medication. For instance, patients with rheumatoid arthritis reported it was a struggle to open some of the medication bottles.

Dr Ayano Kelly, co-author and rheumatologist at Liverpool hospital in NSW, said the trust between the doctor and the patient was about making sure the patient felt they were genuinely cared for, listened to and respected.

“It’s almost normal for people to have difficulty with adherence at some point along their journey, and to be able to help address it, the doctor needs to be aware firstly that this a common problem and create a setting that encourages patients to bring up their concerns and difficulties, and make an effort to address them,” she said.

This could include changing medications, suggesting ways to help build a better medication taking routine, finding ways to reduce side-effects, talking about long term risks or making adjustments to medications to suit a patient’s lifestyle or co-morbidities, Dr Kelly said.

Previous studies found that adherence to medication was between 10% and 46% among patients with gout and between 30% and 80% in patients with rheumatoid arthritis.

In addition, only half of all patients with osteoporosis continued with treatment after one year.

Arthritis Care and Research 2019, 19 July