Automated detection of medication administration errors in neonatal intensive care

ObjectiveTo improve neonatal patient safety through automated detection of medication administration errors (MAEs) in high alert medications including narcotics, vasoactive medication, intravenous fluids, parenteral nutrition, and insulin using the electronic health record (EHR); to evaluate rates of MAEs in neonatal care; and to compare the performance of computerized algorithms to traditional incident reporting for error detection.MethodsWe developed novel computerized algorithms to identify MAEs within the EHR of all neonatal patients treated in a level four neonatal intensive care unit (NICU) in 2011 and 2012. We evaluated the rates and types of MAEs identified by the automated algorithms and compared their performance to incident reporting. Performance was evaluated by physician chart review.ResultsIn the combined 2011 and 2012 NICU data sets, the automated algorithms identified MAEs at the following rates: fentanyl, 0.4% (4 errors/1005 fentanyl administration records); morphine, 0.3% (11/4009); dobutamine, 0 (0/10); and milrinone, 0.3% (5/1925). We found higher MAE rates for other vasoactive medications including: dopamine, 11.6% (5/43); epinephrine, 10.0% (289/2890); and vasopressin, 12.8% (54/421). Fluid administration error rates were similar: intravenous fluids, 3.2% (273/8567); parenteral nutrition, 3.2% (649/20124); and lipid administration, 1.3% (203/15227). We also found 13 insulin administration errors with a resulting rate of 2.9% (13/456). MAE rates were higher for medications that were adjusted frequently and fluids administered concurrently. The algorithms identified many previously unidentified errors, demonstrating significantly better sensitivity (82% vs. 5%) and precision (70% vs. 50%) than incident reporting for error recognition.ConclusionsAutomated detection of medication administration errors through the EHR is feasible and performs better than currently used incident reporting systems. Automated algorithms may be useful for real-time error identification and mitigation.     

Evaluation of the Patient Medication Adherence Questionnaire As a Tool for Self-Reported Adherence Assessment in HIV-Infected Patients on Antiretroviral Regimens

Abstract

Purpose: Adherence to antiretroviral medications is critically important for the success of therapy in patients treated for HIV infection. Patient self-report is a simple method to measure and explore adherence. Even though a variety of surveys have been developed to monitor self-reported adherence, there is no standardized instrument that may be used in routine clinical practice. The usefulness of the Patient Medication Adherence Questionnaire (PMAQ) was evaluated in HIV-infected patients on protease inhibitor (PI)-containing regimens. Method: Data from 149 patients were collected. Study participants completed the PMAQ and provided blood samples to measure plasma HIV-1 RNA concentrations and trough plasma levels of PI. Patients were considered adherent if they had a virologic response and/or had an adequate trough plasma level of PI. Results: A close relationship was found between patient reports of adherence during the previous 4 days and objective measures such as HIV RNA level and plasma levels of PI. Motivation with regard to antiretroviral treatment, confidence in personal skills, and an optimistic attitude to life were identified as important determinants of adherence. On the other hand, sociodemographic background, social support, alcohol and illicit drug use, bothersome symptoms, and depression were not associated with a lower medication adherence. Conclusion: Patients’ psychological and behavioral factors are central in the acceptance and adherence to antiretroviral therapy. To improve the feasibility and the reproducibility of the PMAQ, we propose a revised form of the PMAQ, focusing on the variables identified as strong predictors of adherence.     

Assessing the impact of cognitive impairment on the usability of an electronic medication delivery unit in an assisted living population

PurposeTo examine the relationship between cognitive status and the usability of an integrated medication delivery unit (MDU) in older adults who reside in an Assisted Living Facility (ALF).MethodsSubjects were recruited from a single ALF in Pittsburgh, PA. Usability testing sessions required subjects to execute tasks essential to using EMMA^® (Electronic Medication Management Assistant), a Class II Federal Drug Administration (FDA) approved integrated MDU. Video coding allowed for quantification of usability errors observed during the testing sessions. Each subject's cognitive status was assessed using the Mini Mental State Exam (MMSE^®) with scores <24 indicating cognitive impairment. Functional status was assessed using the Lawton Instrumental Activities of Daily Living (IADL) questionnaire, and a global assessment of subjective usability was assessed by completing the System Usability Scale (SUS). Non-parametric statistics and correlation analysis were used to determine whether significant differences existed between cognitively impaired and non-impaired subjects.ResultsNineteen subjects were recruited and completed the protocol. The subject pool was primarily white, female, 80+ and in possession of above average education. There was a significant relationship between MMSE^® scores and the percentage of task success (z = −2.03, p = 0.04). Subjects with MMSE^® scores of 24+ (no cognitive impairment) successfully completed an average of 69.0% of tasks vs. the 34.7% performance for those in the cognitively impaired group (<24). Six of the unimpaired group also succeeded at meeting the 85% (6 out of 7 correct) threshold. No subject with cognitive impairments (<24 MMSE^®) completed more than 5/7 (71.4%) of their tasks. Two of the impaired subjects failed all of the tasks. Three of the MMSE^®’s subsections (Date, Location and Spell ‘world’ backwards) were found to be significantly related (p < 0.05) to the percentage of task success. Tasks success rates were related with IADL scores (z = −3.826, p < 0.0001), and SUS scores (r = 0.467, p = 0.0429).ConclusionsMedication delivery units like EMMA^® have the potential to improve medication management by combining reminder systems with telemedical monitoring and control capabilities. However, subjects judged to be “cognitively impaired” (<24 MMSE^®) scored a significantly smaller percentage of task success than the “unimpaired” (> = 24), suggesting that cognitive screening of patients prior to the use of EMMA^® may be advisable. Further studies are needed to test the use of EMMA^® amongst ALF residents without cognitive impairment to see if this technology can improve medication adherence.     

The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: A randomized controlled trial

ObjectiveTo evaluate the effects of self-management education tailored to health literacy on medication adherence and blood pressure control.MethodThis randomized controlled trial was conducted in 2018 with 118 elderly people with uncontrolled primary hypertension and inadequate health literacy. Self-management education was developed on the basis of the health literacy index. Medication adherence and blood pressure were assessed using 8-items Morisky Medication Adherence Scale and a mercury sphygmomanometer, respectively.ResultsAt baseline, there were no significant between-group differences regarding participants’ demographic characteristics, medical history, and medication adherence. After the intervention, between-group comparisons adjusted for pretest scores showed a significant reduction in the mean score of systolic and diastolic blood pressure and increase adherence to medication due to intervention (P < 0.05). However, the proportions of controlled systolic and diastolic blood pressure were not statistically significant different between-group (P > 0.05).ConclusionSelf-management education tailored to health literacy significantly promotes medication adherence but has no significant effects on control of blood pressure.Practice implicationTo promote adherence to antihypertensive medications, tailored patient education to Health literacy is recommended. Limited pieces of evidence are available on the effectiveness of health literacy index-based interventions, so further studies are required.     

Association of conflicting information from healthcare providers and poor shared decision making with suboptimal adherence in direct oral anticoagulant treatment: A cross-sectional study in patients with atrial fibrillation

ObjectiveTo assess direct oral anticoagulant (DOAC) adherence and to determine possible determinants for suboptimal adherence in Dutch patients with atrial fibrillation (AF).MethodsCross-sectional study of DOAC users who completed a self-reported questionnaire. Adherence was measured with Morisky8-item Medication Adherence Scale (MMAS-8). Logistic regression analysis was conducted to investigate determinants affecting adherence.Results398 DOAC users completed the questionnaire (mean age 70.6 ± 9.2years). Approximately one in four patients had suboptimal adherence (MMAS-8 < 8). Multivariable analysis showed that patients who felt to have received conflicting information about the treatment, patients with higher educational level and patients who were not sufficiently involved in the treatment choice had a higher odds of suboptimal adherence.ConclusionDOAC adherence was suboptimal. Conflicting information received from different healthcare providers (HCPs), lack of shared decision making and the patients’ educational level were determinants negatively affecting DOAC adherence.Practice implicationsEfforts towards identifying suboptimally adherent DOAC patients are needed since they are at higher risk to develop thromboembolic events. Adherence counselling should be systematically and repeatedly encouraged and shared decision making should become more mainstream. Moreover, reinforced education of both patients and HCPs combined with interprofessional collaboration are potential solutions to prevent knowledge gaps and communication of conflicting information.     

Treatment decision-making in the medical encounter: Comparing the attitudes of French surgeons and their patients in breast cancer care

Objectives

To explore attitudes of French surgeons and their patients towards treatment decision-making (TDM) in the medical encounter.

Methods

Surgeons involved in early stage breast cancer and their patients treated in a French cancer care network received a cross-sectional survey questionnaire containing examples of four different approaches to TDM: paternalistic, “some sharing”, informed TDM and, shared TDM.

Results

Surgeons’ interaction styles were clearly distributed among paternalistic, shared and mixed. The paternalistic approach seemed to be associated with private rather than public practice and with less professional experience. Patients reported a rather low level of participation in TDM, varying by socio-demographic characteristics. One third of patients were dissatisfied with the way their treatment decision had been made.

Conclusion

Most surgeons reported adopting the “some sharing” approach. However, one patient out of three reported that they would have liked to participate more in the TDM process.

Practice implications

Surgeons need to ask patients what their preferences for involvement in TDM are and then think about ways to accommodate both their own and patients’ preferences regarding the TDM process to be used in each encounter. In addition, decision aids could be offered to surgeons to help them discuss treatment options with their patients.     

The effects of a shared decision-making intervention in primary care of depression: a cluster-randomized controlled trial

OBJECTIVE: Patient-centred depression care approaches should better address barriers of insufficient patient information and involvement in the treatment decision process. Additional research is needed to test the effect of increased patient participation on outcomes. The aim of this study was to assess, if patient participation in decision-making via a shared decision-making intervention leads to improved treatment adherence, satisfaction, and clinical outcome without increasing consultation time. METHODS: Cluster-randomized controlled intervention study based on physician training and patient-centered decision aid compared to usual care in primary care settings in Südbaden region of Germany. Twenty-three primary care physicians treating 405 patients with newly diagnosed depression were enrolled. Patient involvement was measured with the patient perceived involvement in care scale (PICS) and a patient participation scale (MSH-scale). Patient satisfaction was measured by the CSQ-8 questionnaire. Treatment adherence was evaluated by patient and provider self-report. Depression severity and remission outcomes were assessed with the Brief PHQ-D. RESULTS: Physician facilitation of patient participation improved significantly and to a greater extent in the intervention compared to the control group. There was no intervention effect for depression severity reduction. Doctor facilitation of patient participation, patient-rated involvement, and physician assessment of adherence improved only in the intervention group. Patient satisfaction at post-intervention was higher in the intervention group compared to the control group. The consultation time did not differ between groups. CONCLUSION: A shared decision-making intervention was better than usual care for improving patient participation in treatment decision-making, and patient satisfaction without increasing consultation time. Additional research is needed to model causal linkages in the decision-making process in regard to outcomes. PRACTICE IMPLICATIONS: The study results encourage the implementation of patient participation in primary care of depression.     

The role of patient attachment and working alliance on patient adherence, satisfaction, and health-related quality of life in lupus treatment

Objective

Researchers tested the hypothesis that patients’ working alliance with their physicians, and patients’ attachment styles would predict patients’ adherence, satisfaction, and health-related quality of life.

Methods

One hundred ninety-three patients diagnosed with lupus participated in an online survey. They completed measures of the Physician–Patient Alliance Inventory, Experiences in Close Relationships Scale, SF-36, General Adherence Inventory, and the Medical Patient Satisfaction Questionnaire.

Results

Working alliance was significantly and positively associated with all three outcome variables of adherence, satisfaction, and quality of life. Attachment avoidance was significantly and negatively related to adherence, and attachment anxiety was significantly and negatively related to health-related quality of life.

Conclusions

A working alliance between physician and patient, characterized by agreement communication on goals and tasks of treatment, along with trust and patient liking of his/her doctor, predicts patient adherence, satisfaction, and quality of life. Psychological dimensions of attachment also predict patient adherence and quality of life.

Practice implications

Doctors and other health service providers ought to actively set goals and tasks of treatment, and foster patient trust and liking. A strong relationship with patients can increase treatment efficacy and effectiveness and improve outcomes for individuals with debilitating chronic illnesses such as lupus.     

出院后个体化护理干预对老年糖尿病患者用药依从性的影响

目的观察出院后个体护理干预对老年糖尿病患者用药依从性的影响效果。 方法选择2012年1月至2012年12月首都医科大学附属北京友谊医院医保内科住院的老年2型糖尿病患者60例,设为常规护理组。2013年1月至2013年12月60例老年2型糖尿病患者设为个体化护理干预组。两组患者住院期间均采用常规护理方法,个体化护理干预组患者出院后由糖尿病专科护士对患者每周2次电话随访,在出院随访3个月后将患者常规复查的血糖化验结果进行资料收集并对患者进行用药依从性评估问卷调查,比较两组患者用药依从性的差异。 结果个体化护理干预组Morisky评分(8.12±0.35)分高于常规护理组(5.64±0.53)分,两组比较差异有统计学意义(t＝2.751, P＝0.032)。个体化护理干预组依从性好于常规护理组,差异有统计学意义(χ²＝17.879, P<0.05)。两组患者出院后3个月空腹血糖、餐后2 h血糖、糖化血红蛋白水平较入院时均有所改善,差异均有统计学意义(P值均小于0.05)。个体化护理干预组经3个月的护理干预后空腹血糖、餐后2 h血糖、糖化血红蛋白水平较常规护理组改善更明显,差异均有显著性统计学意义(P值均小于0.01)。 结论个体化护理干预可有效地提高老年糖尿病患者的用药依从性,更有效地帮助老年糖尿病患者达到控制血糖的目的。     

Provider interaction with the electronic health record: The effects on patient-centered communication in medical encounters

Objective

The computer with the electronic health record (EHR) is an additional ‘interactant’ in the medical consultation, as clinicians must simultaneously or in alternation engage patient and computer to provide medical care. Few studies have examined how clinicians’ EHR workflow (e.g., gaze, keyboard activity, and silence) influences the quality of their communication, the patient's involvement in the encounter, and conversational control of the visit.

Methods

Twenty-three primary care providers (PCPs) from USA Veterans Administration (VA) primary care clinics participated in the study. Up to 6 patients per PCP were recruited. The proportion of time PCPs spent gazing at the computer was captured in real time via video-recording. Mouse click/scrolling activity was captured through Morae, a usability software that logs mouse clicks and scrolling activity. Conversational silence was coded as the proportion of time in the visit when PCP and patient were not talking. After the visit, patients completed patient satisfaction measures. Trained coders independently viewed videos of the interactions and rated the degree to which PCPs were patient-centered (informative, supportive, partnering) and patients were involved in the consultation. Conversational control was measured as the proportion of time the PCP held the floor compared to the patient.

Results

The final sample included 125 consultations. PCPs who spent more time in the consultation gazing at the computer and whose visits had more conversational silence were rated lower in patient-centeredness. PCPs controlled more of the talk time in the visits that also had longer periods of mutual silence.

Conclusions

PCPs were rated as having less effective communication when they spent more time looking at the computer and when there was more periods of silence in the consultation. Because PCPs increasingly are using the EHR in their consultations, more research is needed to determine effective ways that they can verbally engage patients while simultaneously managing data in the EHR.

Practice implications

EHR activity consumes an increasing proportion of clinicians’ time during consultations. To ensure effective communication with their patients, clinicians may benefit from using communication strategies that maintain the flow of conversation when working with the computer, as well as from learning EHR management skills that prevent extended periods of gaze at computer and long periods of silence. Next-generation EHR design must address better usability and clinical workflow integration, including facilitating patient-clinician communication.     

Patient perceived participation in decision making on their antipsychotic treatment: Evidence of validity and reliability of the COMRADE scale in a sample of schizophrenia spectrum disorders

Objective

The aim of this paper is to provide evidence of the validity and reliability of the COMRADE scale (Combined Outcome Measure for Risk communication And treatment Decision making Effectiveness) in patients suffering from schizophrenia spectrum disorders.

Impact of a computerized physician order entry system on nurse-physician collaboration in the medication process

Background

Due to their efficiency and safety potential, computerized physician order entry (CPOE) systems are gaining considerable attention in in-patient settings. However, recent studies have shown that these systems may undermine the efficiency and safety of the medication process by impeding nurse-physician collaboration.

Objective

To evaluate the effects of a CPOE system on the mechanisms whereby nurses and physicians maintain their collaboration in the medication process.

Setting and methodology

Six internal medicine wards at the Erasmus Medical Centre were included in this study. A questionnaire was used to record nurses’ attitudes towards the effectiveness of the former paper-based system. A similar questionnaire was used to evaluate nurses’ attitudes with respect to a CPOE system that replaced the paper-based system. The data were complemented and triangulated through interviews with physicians and nurses.

Results

Response rates for the analyzed questions in the pre- and post-implementation questionnaires were 54.3% (76/140) and 52.14% (73/140). The CPOE system had a mixed impact on medication work: while it improved the main non-supportive features of the paper-based system, it lacked its main supportive features. The interviews revealed more detailed supportive and non-supportive features of the two systems. A comparison of supportive features of the paper-based system with non-supportive features of the CPOE system showed that synchronisation and feedback mechanisms in nurse-physician collaborations have been impaired after the CPOE system was introduced.

Conclusion

This study contributes to an understanding of the affected mechanisms in nurse-physician collaboration using a CPOE system. It provides recommendations for repairing the impaired mechanisms and for redesigning the CPOE system and thus for better supporting these structures.     

Participation of patients and family members in healthcare services at the service and national levels: A lesson learned in Dublin,Ireland

ObjectiveIdentify the current amount and intensity of patient and family participation at the patient, service and national levels from a diabetes and a psychiatric service perspective. Establish the current level of support for greater participation and related characteristics.MethodResearcher-administered questionnaires were conducted with 738 patients and family members in an outpatient type 2 diabetes service and an outpatient psychiatric service, both in Dublin, Ireland.ResultsPatient and family participation at the service and national levels are restricted to the provision of information. Typically no involvement in discussions or the decision -making process is reported. The majority of participants favour greater patient participation at the service level (537/669; 80.3%) and the national level (561/651; 86.2%). Greater support for patient and family member participation is significantly associated with participant’s age, service satisfaction and level of education.ConclusionPatient and family participation is greatest at the patient level. The majority of patients and family members support greater participation at the service and national levels.Practice implicationsThe best way to implement participation needs to be identified. There needs to be a greater focus on participation at the service level. The role of family members also needs to be investigated further.     

Effects of eHealth interventions on medication adherence: a systematic review of the literature

Background

Since medication nonadherence is considered to be an important health risk, numerous interventions to improve adherence have been developed. During the past decade, the use of Internet-based interventions to improve medication adherence has increased rapidly. Internet interventions have the potential advantage of tailoring the interventions to the needs and situation of the patient.

Objective

The main aim of this systematic review was to investigate which tailored Internet interventions are effective in improving medication adherence.

Methods

We undertook comprehensive literature searches in PubMed, PsycINFO, EMBASE, CINAHL, and Communication Abstracts, following the guidelines of the Cochrane Collaboration. The methodological quality of the randomized controlled trials and clinical controlled trials and methods for measuring adherence were independently reviewed by two researchers.

Results

A total of 13 studies met the inclusion criteria. All included Internet interventions clearly used moderately or highly sophisticated computer-tailored methods. Data synthesis revealed that there is evidence for the effectiveness of Internet interventions in improving medication adherence: 5 studies (3 high-quality studies and 2 low-quality studies) showed a significant effect on adherence; 6 other studies (4 high-quality studies and 2 low-quality studies) reported a moderate effect on adherence; and 2 studies (1 high-quality study and 1 low-quality study) showed no effect on patients’ adherence. However, most studies used self-reported measurements to assess adherence, which is generally perceived as a low-quality measurement. In addition, we did not find a clear relationship between the quality of the studies or the level of sophistication of message tailoring and the effectiveness of the intervention. This might be explained by the great difference in study designs and the way of measuring adherence, which makes results difficult to compare. There was also large variation in the measured interval between baseline and follow-up measurements.

Conclusion

This review shows promising results on the effectiveness of Internet interventions to enhance patients’ adherence to prescribed long-term medications. Although there is evidence according to the data synthesis, the results must be interpreted with caution due to low-quality adherence measurements. Future studies using high-quality measurements to assess medication adherence are recommended to establish more robust evidence for the effectiveness of eHealth interventions on medication adherence.     

Impact of errors in paper-based and computerized diabetes management with decision support for hospitalized patients with type 2 diabetes. A post-hoc analysis of a before and after study

ObjectiveMost preventable adverse drug events and medication errors occur during medication ordering. Medication order entry and clinical decision support are available on paper or as computerized systems. In this post-hoc analysis we investigated frequency and clinical impact of blood glucose (BG) documentation- and user-related calculation errors as well as workflow deviations in diabetes management. We aimed to compare a paper-based protocol to a computerized medication management system combined with clinical workflow and decision support.MethodsSeventy-nine hospitalized patients with type 2 diabetes mellitus were treated with an algorithm driven basal-bolus insulin regimen. BG measurements, which were the basis for insulin dose calculations, were manually entered either into the paper-based workflow protocol (PaperG: 37 patients) or into GlucoTab^®—a mobile tablet PC based system (CompG: 42 patients). We used BG values from the laboratory information system as a reference. A workflow simulator was used to determine user calculation errors as well as workflow deviations and to estimate the effect of errors on insulin doses. The clinical impact of insulin dosing errors and workflow deviations on hypo- and hyperglycemia was investigated.ResultsThe BG documentation error rate was similar for PaperG (4.9%) and CompG group (4.0%). In PaperG group, 11.1% of manual insulin dose calculations were erroneous and the odds ratio (OR) of a hypoglycemic event following an insulin dosing error was 3.1 (95% CI: 1.4–6.8). The number of BG values influenced by insulin dosing errors was eightfold higher than in the CompG group. In the CompG group, workflow deviations occurred in 5.0% of the tasks which led to an increased likelihood of hyperglycemia, OR 2.2 (95% CI: 1.1–4.6).DiscussionManual insulin dose calculations were the major source of error and had a particularly strong influence on hypoglycemia. By using GlucoTab^®, user calculation errors were entirely excluded. The immediate availability and automated handling of BG values from medical devices directly at the point of care has a high potential to reduce errors. Computerized systems facilitate the safe use of more complex insulin dosing algorithms without compromising usability. In CompG group, missed or delayed tasks had a significant effect on hyperglycemia, while in PaperG group insufficient precision of documentation times limited analysis. The use of old BG measurements was clinically less relevant.ConclusionInsulin dosing errors and workflow deviations led to measurable changes in clinical outcome. Diabetes management systems including decision support should address nurses as well as physicians in a computerized way. Our analysis shows that such systems reduce the frequency of errors and therefore decrease the probability of hypo- and hyperglycemia.     

A methodology for shifting the focus of e-health support design onto user needs: a case in the homecare field

BACKGROUND: Epidemiological shifts, financial pressures and changing policy priorities in healthcare initiate reflections on innovative ways to deliver care. Technologies offer opportunities to change health services delivery. One of the emerging fields is telehomecare-applications. Yet, these applications are not always adapted to the user needs and characteristics of the homecare setting, resulting in "system failure". OBJECTIVES: We describe a generic methodological model to incorporate user perspectives in the design and development process of e-health systems. The model aims at grounding the choice of the technology in a clear understanding of the homecare field, and on interactive reflections with the technology developers. METHODS AND RESULTS: The methodological model develops over three phases. A first phase aims to identify and to select potential patient groups for which the technology will be developed: It holds (a) gathering of epidemiological data; (b) identifying relevant inclusion criteria to select patient groups; (c) qualitative weighting based on the inclusion criteria to include potential patient groups and (d) plenary discussion with the technology developers. In a second phase, the particular needs of the selected patient groups are assessed through literature review, document analysis and explorative interviews with key informants. In the third phase, "social" use cases are developed in which the use of potential technologies is written as virtual storylines. The writing of the use cases is prepared through a semi-structured questionnaire for all partners listing the "visions and expectations on the technology and user context". The use cases are the source documents for a plenary discussion with the technology developers in which priorities are set for functionalities of the e-homecare platform. The methodological approach is illustrated within the Coplintho-project. It is a Flemish initiative developing an e-homecare platform offering a package of services on a dedicated device to support the social integration and 'independent living' of people in their home environment. DISCUSSION: Our methodological approach provides a practical framework for understanding and considering user perspectives. The application of the method within the development of the Coplintho-e-homecare platform demonstrated its usefulness. The experience within the Coplintho-pilot project learned important lessons about the operational use of the method. The methodology is time-consuming and requires scientific input to assess and to document potential user needs, requiring specific means and human resources. The method also requires a very explicit project management of the preparatory phase.     

Effectiveness of a group-based intervention to change medication beliefs and improve medication adherence in patients with rheumatoid arthritis: A randomized controlled trial

Objective

To assess the effect of a group-based intervention on the balance between necessity beliefs and concern beliefs about medication and on medication non-adherence in patients with rheumatoid arthritis (RA).

Methods

Non-adherent RA patients using disease-modifying anti-rheumatic drugs (DMARDs) were randomized to an intervention or control arm. The intervention consisted, amongst others, of two motivational interviewing-guided group sessions led by the same pharmacist. Control patients received brochures about their DMARDs. Questionnaires were completed up to 12 months follow-up.

Results

123 patients (mean age: 60 years, female: 69%) were randomized. No differences in necessity beliefs and concern beliefs about medication and in medication non-adherence were detected between the intervention and control arm, except at 12 months’ follow-up: participants in the intervention arm had less strong necessity beliefs about medication than participants in the control arm (b: −1.0 (95% CI: −2.0, −0.1)).

Conclusion

This trial did not demonstrate superiority of our intervention over the control arm in changing beliefs about medication or in improving medication adherence over time.

Practice implications

Absent intervention effects might have been due to, amongst others, selection bias and a suboptimal treatment integrity level. Hence, targeting beliefs about medication in clinical practice should not yet be ruled out.