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Exploring strategies to support medication adherence in patients with inflammatory arthritis: a patient-oriented qualitative study using an interactive focus group activity

Authors Rai SK, Howren A, Wilcox ES, Townsend AF, Marra CA, Aviña-Zubieta JA, De Vera MA

Received 19 May 2018

Accepted for publication 17 July 2018

Published 5 October 2018 Volume 2018:12 Pages 2015—2025

DOI https://doi.org/10.2147/PPA.S174672

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Cristina Weinberg

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen


Video abstract presented by Mary A De Vera.

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Sharan K Rai,1 Alyssa Howren,1,2 Elizabeth S Wilcox,3 Anne F Townsend,1,4 Carlo A Marra,1,5 J Antonio Aviña-Zubieta,1,6 Mary A De Vera1,2

1Arthritis Research Canada, Vancouver, BC, Canada; 2Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada; 3School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; 4University of Exeter Medical School, Exeter, UK; 5School of Pharmacy, Otago University, Dunedin, New Zealand; 6Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada

Objective: Medication non-adherence is a substantial problem among patients with inflammatory arthritis (IA). Our aim was to explore IA patients’ perspectives on strategies to support medication adherence.
Methods: We collaborated with a leading arthritis patient group and conducted a qualitative study on individuals with IA who were taking at least one medication for their IA. An experienced facilitator led participants through a focus group exercise where participants were asked to design, and then discuss, strategies and/or tools supporting medication use. We applied thematic analysis using an iterative, constant comparative approach.
Results: We studied six focus groups with 27 participants diagnosed with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and comparatively under-represented conditions in this research area such as Sjögren’s syndrome. Five themes emerged throughout the analysis. Two themes – 1) adapting to life with IA and 2) the complexities and dynamic nature of taking medications – describe learning to live with a chronic condition and the challenges encountered when using long-term medications. Three themes – 3) developing lifestyle strategies for medication use (eg, having physical reminders and prompts), 4) becoming informed about medications (eg, information at time of diagnosis, means of receiving information) and 5) receiving support (eg, from health care team members, from family) – offer perspectives on facilitators to medication use. From the relationship between the latter themes, a framework was developed that encompasses means of receiving information and support as actionable targets for patient-oriented adherence interventions for IA.
Conclusion: This patient-oriented study highlights the importance of developing timely adherence interventions for IA. Our findings also led to a framework describing means of receiving information, such as through digital media and support, including from health care team members and family, as actionable targets for patient-oriented adherence interventions for IA.

Keywords: inflammatory arthritis, medication adherence, concordance, facilitators, barriers, qualitative research, synthetic DMARDs, biologic DMARDs

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