Monash Nursing & Midwifery, Monash University, Melbourne, Victoria, Australia.
Federation University, Berwick, Victoria, Australia.
Int J Rheum Dis. 2019 Sep;22(9):1695-1705. doi: 10.1111/1756-185X.13660. Epub 2019 Jul 19.
Medication non-adherence is prevalent among patients with rheumatoid arthritis (RA). Rheumatologists are specialists in medication prescribing and counselling for RA, but their insights regarding medication adherence have not been studied.
To explore rheumatologists' insights into medication adherence in patients with RA.
A qualitative study using semi-structured interviews with 10 rheumatologists in Iran was undertaken. Thematic analysis was conducted to identify how rheumatologists assess medication adherence and their perceived determinants of adherence. The identified determinants of adherence were mapped according to the Andersen's Behavioral Model of Health Service Use.
Six participants were male, and the mean age was 47 years. The mean years of experience as a rheumatologist was 8.6 (SD = 7.1) years. Rheumatologists did not use a validated tool for medication adherence assessment. They assessed medication adherence either by asking their patients simple questions or using laboratory test results. The identified determinants of adherence were divided into 3 groups: patient-, rheumatologist- and healthcare organization-related determinants. The proposed suggestions to improve adherence were: (a) to understand a patient's financial situation before prescribing more expensive medications; (b) to employ a dose-reducing strategy; (c) to give hope to patients regarding remission; and (d) to arrange a session with the nurse educator.
The findings of this study provide insight into rheumatologists' perspectives on medication adherence of patients with RA. The identified determinants of adherence could be considered when developing initiatives to improve medication adherence in this group of patients.
类风湿关节炎（RA）患者普遍存在药物治疗不依从的情况。风湿病学家是专门从事 RA 药物处方和咨询的专家，但他们对药物依从性的看法尚未得到研究。
探讨风湿病学家对 RA 患者药物依从性的看法。
采用半结构式访谈对伊朗的 10 名风湿病学家进行了定性研究。采用主题分析来确定风湿病学家如何评估药物依从性以及他们认为的依从性决定因素。根据安德森健康服务利用行为模型，对确定的依从性决定因素进行了映射。
6 名参与者为男性，平均年龄为 47 岁。作为风湿病学家的平均从业年限为 8.6 年（SD=7.1）。风湿病学家未使用经过验证的药物依从性评估工具。他们通过询问患者简单的问题或使用实验室检查结果来评估药物依从性。确定的依从性决定因素分为 3 组：患者、风湿病学家和医疗保健组织相关的决定因素。提出的改善依从性的建议包括：（a）在开更昂贵的药物之前，了解患者的财务状况；（b）采用减少剂量的策略；（c）让患者对缓解抱有希望；（d）安排与护士教育者的会面。
本研究的结果深入了解了风湿病学家对 RA 患者药物依从性的看法。在制定改善这组患者药物依从性的措施时，可以考虑确定的依从性决定因素。
