Roodenrijs Nadia M T, van der Goes Marlies C, Welsing Paco M J, van Oorschot Eline P C, Nikiphorou Elena, Nijhof Nienke C, Tekstra Janneke, Lafeber Floris P J G, Jacobs Johannes W G, van Laar Jacob M, Geenen Rinie
Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht.
Department of Rheumatology, Meander Medical Center, Amersfoort, the Netherlands.
Rheumatology (Oxford). 2021 Nov 3;60(11):5105-5116. doi: 10.1093/rheumatology/keab130.
Treatment non-adherence is more frequent among difficult-to-treat (D2T) than among non-D2T RA patients. Perceptions of non-adherence may differ. We aimed to thematically structure and prioritize barriers to (i.e. causes and reasons for non-adherence) and facilitators of optimal adherence from the patients' and rheumatologists' perspectives.
Patients' perceptions were identified in semi-structured in-depth interviews. Experts selected representative statements regarding 40 barriers and 40 facilitators. Twenty D2T and 20 non-D2T RA patients sorted these statements during two card-sorting tasks: first, by order of content similarity and, second, content applicability. Additionally, 20 rheumatologists sorted the statements by order of content applicability to the general RA population. The similarity sorting was used as input for hierarchical cluster analysis. The applicability sorting was analysed using descriptive statistics, prioritized and the results compared between D2T RA patients, non-D2T RA patients and rheumatologists.
Nine clusters of barriers were identified, related to the healthcare system, treatment safety/efficacy, treatment regimen and patient behaviour. D2T RA patients prioritized adverse events and doubts about effectiveness as the most important barriers. Doubts about effectiveness were more important to D2T than to non-D2T RA patients (P = 0.02). Seven clusters of facilitators were identified, related to the healthcare system and directly to the patient. All RA patients and rheumatologists prioritized a good relationship with the healthcare professional and treatment information as the most helpful facilitators.
D2T RA patients, non-D2T RA patients and rheumatologists prioritized perceptions of non-adherence largely similarly. The structured overviews of barriers and facilitators provided in this study may guide improvement of adherence.
与非难治性类风湿关节炎（RA）患者相比，难治性（D2T）RA患者的治疗不依从情况更为常见。对不依从的认知可能存在差异。我们旨在从患者和风湿病学家的角度，对不依从的障碍（即不依从的原因）和最佳依从性的促进因素进行主题构建并确定其优先级。
通过半结构化深度访谈确定患者的认知。专家们挑选了关于40个障碍和40个促进因素的代表性陈述。20名D2T RA患者和20名非D2T RA患者在两项卡片分类任务中对这些陈述进行分类：首先，按照内容相似性排序；其次，按照内容适用性排序。此外，20名风湿病学家按照陈述对一般RA人群的内容适用性进行排序。相似性排序用作层次聚类分析的输入。使用描述性统计分析适用性排序，确定优先级，并比较D2T RA患者、非D2T RA患者和风湿病学家之间的结果。
确定了9个障碍类别，与医疗保健系统、治疗安全性/有效性、治疗方案和患者行为有关。D2T RA患者将不良事件和对有效性的怀疑列为最重要的障碍。对有效性的怀疑对D2T RA患者比对非D2T RA患者更重要（P = 0.02）。确定了7个促进因素类别，与医疗保健系统以及直接与患者有关。所有RA患者和风湿病学家都将与医疗保健专业人员的良好关系和治疗信息列为最有帮助的促进因素。
D2T RA患者、非D2T RA患者和风湿病学家对不依从认知的优先级在很大程度上相似。本研究中提供的障碍和促进因素的结构化概述可能会指导依从性的改善。
