Voshaar M J H, Vriezekolk J E, van Dulmen A M, van den Bemt B J F, van de Laar M A F J
Department Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.
Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
BMC Musculoskelet Disord. 2021 Jan 6;22(1):21. doi: 10.1186/s12891-020-03874-2.
Facilitators and barriers of adherence to disease-modifying anti-rheumatic drugs (DMARDs) have been identified by patients with inflammatory arthritis earlier. However, the relative importance from the patients' perspective of these factors is unknown. Knowledge on this ranking might guide the development of interventions and may facilitate targeted communication on adherence. This study aims to examine 1) the relative importance patients attach to facilitators and barriers for DMARDs adherence, and 2) the relationship between patient characteristics and ranking of these factors.
One hundred twenty-eight outpatients with inflammatory arthritis; (60% female, mean age 62 years (SD = 12), median disease duration 15 years, IQR (7, 23) participated in a Maximum Difference scaling exercise and ranked 35 items based upon previously identified facilitators and barriers to medication adherence. Hierarchical Bayes estimation was used to compute mean Rescaled Probability Scores (RPS; 0-100) (i.e. relative importance score). Kendall's coefficient of concordance was used to examine a possible association between patients' characteristics (i.e. age, sex and educational level) and ranking of the items.
The three most important items ranked by patients were: Reduction of symptoms formulated as "Arthritis medications help to reduce my symptoms" (RPS = 7.30, CI 7.17-7.44), maintaining independence formulated as "I can maintain my independence as much as possible" (RPS = 6.76, CI 6.54-6.97) and Shared decision making formulated as "I can decide -together with my physician- about my arthritis medications" (RPS = 6.48, CI 6.24-6.72). No associations between patient characteristics and ranking of factors were found.
Reducing symptoms, maintaining independency and shared decision making are patients' most important factors for DMARDs adherence. This knowledge might guide the development of interventions and may facilitate communication between health professionals and their patients on medication adherence.
炎性关节炎患者较早识别出了改善病情抗风湿药物（DMARDs）依从性的促进因素和障碍。然而，从患者角度来看，这些因素的相对重要性尚不清楚。了解这一排名可能会指导干预措施的制定，并有助于就依从性进行有针对性的沟通。本研究旨在探讨：1）患者对DMARDs依从性的促进因素和障碍所赋予的相对重要性；2）患者特征与这些因素排名之间的关系。
128例炎性关节炎门诊患者（60%为女性，平均年龄62岁（标准差=12），疾病持续时间中位数为15年，四分位距（IQR）为（7,23））参与了最大差异量表练习，并根据先前确定的药物依从性促进因素和障碍对35个项目进行了排名。采用分层贝叶斯估计来计算平均重新标度概率得分（RPS；0 - 100）（即相对重要性得分）。肯德尔和谐系数用于检验患者特征（即年龄、性别和教育水平）与项目排名之间的可能关联。
患者排名最重要的三个项目分别是：表述为“关节炎药物有助于减轻我的症状”的症状减轻（RPS = 7.30，CI 7.17 - 7.44）、表述为“我可以尽可能保持独立”的保持独立（RPS = 6.76，CI 6.54 - 6.97）以及表述为“我可以与我的医生一起决定我的关节炎药物治疗方案”的共同决策（RPS = 6.48，CI 6.24 - 6.72）。未发现患者特征与因素排名之间存在关联。
减轻症状、保持独立和共同决策是患者对DMARDs依从性最重要的因素。这一认识可能会指导干预措施的制定，并有助于医护人员与患者就药物依从性进行沟通。
