Abstract
This study assessed self-reported adherence in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) from underserved healthcare settings. We conducted a cross-sectional survey of 102 ethnically diverse patients—70 with RA and 32 with SLE—attending rheumatology clinics at publicly funded hospitals in Houston, Texas; 43% were Hispanic, 32% African-American, and 25% White. Treatment adherence was evaluated using the compliance questionnaire rheumatology (CQR; 0, low adherence and 100, high adherence) and the questionnaire of the Adult AIDS Clinical Trials Group (AACTG). The patients were also asked how often they forgot to take their prescribed medications or discontinued them on their own. Mean patient age was 48.5 years; 75% were female, 32% were African-American, 43% Hispanic, and 25% White. Only one third reported never forgetting to take their medications; 40% reported having stopped their medications on their own because of side effects, and 20% because of lack of efficacy. Mean CQR score was 69.1 ± 10.5, suggesting moderate adherence overall. Differences were also observed across ethnic groups: 23% of ethnic minority patients had problems taking their medications at specified times compared to 11% of Whites (p = 0.03). Lower education and side effects were associated with lower adherence. No differences were observed between RA and SLE patients. Many patients with RA and SLE report problems with treatment adherence. These appear to be more prevalent in African Americans and Hispanics than Whites; the impact of decreased adherence on outcomes could be significant and should be considered when treating patients with RA and SLE.
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References
Bond WSHD (1991) Detection methods and strategies for improving medication compliance. Am J Hosp Pharm 48(9):1978–1988 Sep
Viller F, Guillemin F, Briancon S, Moum T, Suurmeijer T, van den HW (1999) Compliance to drug treatment of patients with rheumatoid arthritis: a 3 year longitudinal study. J Rheumatol 26(10):2114–2122 Oct
Deyo RA, Inui TS, Sullivan B (1981) Noncompliance with arthritis drugs: magnitude, correlates, and clinical implications. J Rheumatol 8(6):931–936 Nov
Lee P, Tan LJ (1979) Drug compliance in outpatients with rheumatoid arthritis. Aust N Z J Med 9(3):274–277 Jun
Pullar T, Peaker S, Martin MF, Bird HA, Feely MP (1988) The use of a pharmacological indicator to investigate compliance in patients with a poor response to antirheumatic therapy. Br J Rheumatol 27(5):381–384 Oct
Mosley-Williams A, Lumley MA, Gillis M, Leisen J, Guice D (2002) Barriers to treatment adherence among African American and white women with systemic lupus erythematosus. Arthritis Rheum 47(6):630–638 Dec 15
Balant LP, Balant-Gorgia EA (2000) Cultural differences: implications on drug therapy and global drug development. Int J Clin Pharmacol Ther 38(2):47–52 Feb
Charles H, Good CB, Hanusa BH, Chang CC, Whittle J (2003) Racial differences in adherence to cardiac medications. J Natl Med Assoc 95(1):17–27 Jan
Dunbar-Jacob J, Holmes JL, Sereika S, Kwoh CK, Burke LE, Starz TW et al (2004) Factors associated with attrition of African Americans during the recruitment phase of a clinical trial examining adherence among individuals with rheumatoid arthritis. Arthritis Rheum 51(3):422–428 Jun 15
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31(3):315–324 Mar
Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF et al (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25(11):1271–1277 Nov
de Klerk E, van der Heijde D, Landewe R, van der Tempel H, van der Linden S (2003) The compliance-questionnaire-rheumatology compared with electronic medication event monitoring: a validation study. J Rheumatol 30:2469–2475
Chesney MA, Ickovics JR, Chambers DB, Gifford AL, Neidig J, Zwickl B et al (2000) Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care 12(3):255–266 Jun
Barber N, Parsons J, Clifford S, Darracott R, Horne R, Coons SJ (2004) Patients’ problems with new medication for chronic conditions. Qual Saf Health Care 13(3):172–175 Jun 1
Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353(5):487–497 Aug 4
de Klerk E, van der HD, van der TH, van der LS (1999) Development of a questionnaire to investigate patient compliance with antirheumatic drug therapy. J Rheumatol 26(12):2635–2641 Dec
Graveley EA, Oseasohn CS (1991) Multiple drug regimens: medication compliance among veterans 65 years and older. Res Nurs Health 14(1):51–58 Feb
Hill MN, Bone LR, Kim MT, Miller DJ, Dennison CR, Levine DM (1999) Barriers to hypertension care and control in young urban black men. Am J Hypertens 12(1O Pt 1):951–958 Oct
Neff JA, Crawford SL (1998) The Health Belief Model and HIV risk behaviours: a causal model analysis among Anglos, African-Americans and Mexican-Americans. Ethn Health 3(4):283–299 Nov
Pearlman DN, Rakowski W, Ehrich B, Clark MA (1996) Breast cancer screening practices among black, Hispanic, and white women: reassessing differences. Am J Prev Med 12(5):327–337 Sep
Garcia Popa-Lisseanu MG, Greisinger A, Richardson M, O'Malley KJ, Janssen NM, Marcus DM et al (2005) Determinants of treatment adherence in ethnically diverse, economically disadvantaged patients with rheumatic disease. J Rheumatol 32(5):913–919 May
Petri M, Perez-Gutthann S, Longenecker JC, Hochberg M (1991) Morbidity of systemic lupus erythematosus: role of race and socioeconomic status. Am J Med 91(4):345–353 Oct
Glave-Testino C, Cardiel MH, Arce-Salinas A, Alarcon-Segovia D (1994) Factors associated with disease severity in Mexican patients with rheumatoid arthritis. Clin Exp Rheumatol 12(6):589–594 Nov
Acknowledgment
This study is supported by a grant from the National Institute for Arthritis, Musculoskeletal and Skin Disorders (NIAMS; R01 AR47858) and, in part, by the Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. Dr. Suarez-Almazor has a K24 career award from NIAMS and is the Director of the Houston Center for Education and Research on Therapeutics funded by the Agency for Health Quality and Research (U18 HS016093).
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Garcia-Gonzalez, A., Richardson, M., Garcia Popa-Lisseanu, M. et al. Treatment adherence in patients with rheumatoid arthritis and systemic lupus erythematosus. Clin Rheumatol 27, 883–889 (2008). https://doi.org/10.1007/s10067-007-0816-6
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DOI: https://doi.org/10.1007/s10067-007-0816-6