Kumar Kanta, Raza Karim, Gill Paramjit, Greenfield Sheila
Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK; Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
Institute of Inflammation and Ageing, University of Birmingham, UK; Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
Patient Prefer Adherence. 2016 Jun 16;10:1091-100. doi: 10.2147/PPA.S99702. eCollection 2016.
Medication can ease symptoms and limit disease progression in rheumatoid arthritis (RA). Despite this, nonadherence to medication is common in RA. We explored the determinants of high and low adherence to disease-modifying antirheumatic drugs (DMARDs) in patients with RA and provide suggestions on approaches to improving adherence to DMARDs.
Patients with RA were identified from those who had previously participated in a questionnaire measuring levels of medication adherence. Twenty patients participated (ten high and ten low adherers, as determined by responses to the Medication Adherence Report Scale). In-depth individual semistructured interviews were undertaken until data saturation was reached. Interviews were transcribed and analyzed using a constant comparative method.
Four main themes related to adherence were identified: 1) symptom severity; 2) illness perception; 3) perceived benefits and risks of DMARDs; and 4) the quality and quantity of information about RA and DMARDs. In addition, patients' suggestions about strategies to optimize adherence to DMARDs were captured and they fell within the following themes: 1) musculoskeletal ultrasound to explain the disease process and to provide objective feedback about the extent to which their disease activity is being effectively controlled; 2) better explanations of the consequences of poorly controlled RA; and 3) a good relationship with the health professional.
Patients' beliefs about medicines, perceptions about RA, and level of satisfaction with information about DMARDs influenced their adherence to DMARDs. The use of musculoskeletal ultrasound to image the inflamed joint may help to improve patient adherence to DMARDs.
药物治疗可缓解类风湿关节炎（RA）的症状并限制疾病进展。尽管如此，RA患者中药物治疗不依从的情况很常见。我们探讨了RA患者对改善病情抗风湿药（DMARDs）高依从性和低依从性的决定因素，并就提高DMARDs依从性的方法提出建议。
从之前参与过测量药物依从性水平问卷的人群中识别出RA患者。共有20名患者参与（根据药物依从性报告量表的回答确定，10名高依从者和10名低依从者）。进行深入的个人半结构化访谈，直至达到数据饱和。访谈内容进行转录，并采用持续比较法进行分析。
确定了与依从性相关的四个主要主题：1）症状严重程度；2）疾病认知；3）对DMARDs的感知益处和风险；4）关于RA和DMARDs的信息质量和数量。此外，还收集了患者关于优化DMARDs依从性策略的建议，这些建议属于以下主题：1）使用肌肉骨骼超声来解释疾病过程，并提供关于其疾病活动得到有效控制程度的客观反馈；2）更好地解释RA控制不佳的后果；3）与医疗专业人员建立良好关系。
患者对药物的信念、对RA的认知以及对DMARDs信息的满意度影响了他们对DMARDs的依从性。使用肌肉骨骼超声对发炎关节进行成像可能有助于提高患者对DMARDs的依从性。
