Hayden Charlotte, Neame Rebecca, Tarrant Carolyn
Department of Health Sciences, University of Leicester, Leicester, UK.
Department of Rheumatology, Leicester Royal Infirmary, Leicester, UK.
BMJ Open. 2015 May 20;5(5):e006918. doi: 10.1136/bmjopen-2014-006918.
Methotrexate is effective in treating inflammatory arthritis, but both underadherence and overadherence can put patients at risk. Patients may fail to adhere due to practicalities including the unusual weekly dosing regimen, but medication beliefs also play a role. This study explored how both beliefs about necessity and concerns about methotrexate become established in patients with inflammatory arthritis and how patients use information in managing their beliefs and concerns.
Semistructured interviews were conducted with patients taking oral methotrexate for inflammatory arthritis. Interviews were transcribed verbatim and analysed thematically.
Participants were recruited from a single Trust in the East Midlands.
Fifteen patients (4 male, 11 female) with inflammatory arthritis.
Methotrexate was commonly prescribed at the time of diagnosis; at this point, experience of illness was influential for beliefs about medication necessity. Following prescription, patients absorbed information from written and verbal sources which reinforced beliefs about necessity but also raised concerns, including fear of side effects. Over time, beliefs were modified on the basis of personal experience, particularly of medication effectiveness and side effects. Some patients described tensions and dissonance in their beliefs and experiences of methotrexate, which put them at risk of non-adherence. Patients used information-seeking and information-avoidance as strategies to resolve these tensions. The available information did little to help suppress dissonance and sometimes exacerbated it.
Patients' experiences of coming to terms with taking methotrexate are complex, and their experiences of dissonance are particularly problematic. Experiences might be improved by supporting patients to assess necessity (particularly in the presence of side effects) and by providing information to moderate unnecessary concerns. Improving recording and sharing of monitoring results may be one way to meet these needs.
甲氨蝶呤对治疗炎性关节炎有效，但用药依从性不足和过度依从都会使患者面临风险。患者可能因实际问题（包括不寻常的每周给药方案）而无法坚持用药，但用药观念也起到一定作用。本研究探讨了炎性关节炎患者如何形成对用药必要性的信念以及对甲氨蝶呤的担忧，以及患者如何利用信息来管理自己的信念和担忧。
对服用口服甲氨蝶呤治疗炎性关节炎的患者进行半结构式访谈。访谈内容逐字转录并进行主题分析。
参与者从东米德兰兹郡的一个医疗信托机构招募。
15名炎性关节炎患者（4名男性，11名女性）。
甲氨蝶呤通常在诊断时就开始使用；此时，患病经历对用药必要性的信念有影响。开出处方后，患者从书面和口头渠道获取信息，这些信息强化了对必要性的信念，但也引发了担忧，包括对副作用的恐惧。随着时间的推移，信念会根据个人经历进行调整，尤其是用药效果和副作用方面的经历。一些患者描述了他们在甲氨蝶呤的信念和经历中存在紧张和不一致，这使他们有不依从的风险。患者采用寻求信息和回避信息的策略来解决这些紧张关系。现有的信息对抑制不一致作用不大，有时还会加剧这种情况。
患者接受服用甲氨蝶呤的经历很复杂，他们的不一致经历尤其成问题。通过支持患者评估必要性（尤其是在有副作用的情况下）以及提供信息以缓解不必要的担忧，可能会改善患者经历。改善监测结果的记录和共享可能是满足这些需求的一种方式。
