Recommendations for the assessment and optimization of adherence to disease-modifying drugs in chronic inflammatory rheumatic diseases: A process based on literature reviews and expert consensus - 15/01/19
, Anna Molto d, e, Xavier Romand f, g, Déborah Puyraimond-Zemmour a, b, c, Matthieu Lavielle d, e, Catherine Beauvais h, Eric Senbel i, René-Marc Flipo j, Sophie Pouplin k, Christophe Richez l, m, Alain Saraux n, o, Maryse Mézières d, e, Loriane Gutermann d, e, Philippe Gaudin f, g, Daniel Wendling p, q, Maxime Dougados d, eBienvenue sur EM-consulte, la référence des professionnels de santé.
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Highlights |
• | Non-adherence to medications in chronic inflammatory rheumatic diseases is a frequent and deleterious issue. |
• | Using an evidence-based approach followed by expert consensus, recommendations to assess and improve medication adherence in CIRDs have been developed. |
• | Adherence should be assessed at each outpatient visit, at least using an open question. |
• | Patient information and education, and patient/physician shared decision, are key to optimize adherence. |
• | Formalized education sessions, motivational interviewing and cognitive behavioral therapy may be useful to improve adherence. |
Abstract |
Background |
Adherence to treatment is a key issue in chronic inflammatory rheumatic diseases (CIRDs).
Objective |
To develop recommendations to facilitate in daily practice, the management of non-adherence to disease-modifying drugs in patients with rheumatoid arthritis, spondyloarthritis, psoriatic arthritis, connective tissue diseases or other CIRDs.
Methods |
The process comprised (a) systematic literature reviews of methods (including questionnaires) to measure non-adherence, risk factors for non-adherence and efficacy of targeted interventions; (b) development of recommendations through consensus of 104 rheumatologist and nurse experts; (c) assessment of agreement and ease of applicability (1–5 where 5 is highest) by the 104 experts.
Results |
(a) Overall, 274 publications were analysed. (b) The consensus process led to 5 overarching principles and 10 recommendations regarding adherence. Key points include that adherence should be assessed at each outpatient visit, at least using an open question; questionnaires and hydroxychloroquine blood level assessments may also be useful. Risk factors associated to non-adherence were listed. Patient information and education, and patient/physician shared decision, are key to optimize adherence. Other techniques such as formalized education sessions, motivational interviewing and cognitive behavioral therapy may be useful. All health professionals can get involved and e-health may be a support. (c) The agreement with the recommendations was high (range of means, 3.9–4.5) but ease of applicability was lower (2.7–4.4).
Conclusions |
Using an evidence-based approach followed by expert consensus, this initiative should improve the assessment and optimization of adherence in chronic inflammatory rheumatic disorders.
Le texte complet de cet article est disponible en PDF.Keywords : Adherence, Compliance, Rheumatoid arthritis, Spondyloarthritis, Recommendations
Plan
Vol 86 - N° 1
P. 13-19 - janvier 2019 Retour au numéro
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