Digital health leaders are tackling the issue of medication adherence, which is a significant problem for people with rheumatoid arthritis, according to a new study from the University of Manchester.
Even pain doesn’t ensure that people will follow treatment plans
Contrary to popular belief, people with rheumatoid arthritis don’t always take their medication as prescribed. New research from the Arthritis Research UK Center for Epidemiology at the University of Manchester found that the nagging pain of rheumatoid arthritis itself is not enough to ensure medication adherence.
In fact, the study—published in the journal Rheumatology—found that 40 percent of patients had low scores on an adherence questionnaire at least once during their 18-month study. This indicates that not all patients are taking their medication therapies, some of which are quite expensive, as regularly as prescribed.
Rheumatoid arthritis, the most common inflammatory joint disorder in the UK, causes joint pain and swelling, stiffness, and fatigue. Rheumatoid arthritis affects approximately 400,000 adults in the UK, and some 1.5 million adults in the US.
There is no way to predict how the disease will impact a person’s life. After initial diagnosis, most rheumatoid arthritis patients (75 percent) will continue to have some level of joint pain and stiffness throughout their lives, 20 percent will always have mild rheumatoid arthritis and 5 percent will be disabled by it.
Belinda Wadsworth, head of Health Promotion and Engagement at Arthritis Research UK said:
Healthcare professionals and other information providers need to find more effective ways to inform their patients about the importance of taking drugs as prescribed for them. People with rheumatoid arthritis need to feel empowered to keep their condition under control by having a better understanding of why their medication is less effective if they don't take it as directed.
The University of Manchester research team identified potential explanations for patient behavior. Those who had positive views of the drug’s necessity and those with fewer concerns about potential side effects, for example, were more likely to take their medication as prescribed.
The patient’s view of rheumatoid arthritis (e.g., its potential severity and chronic nature), those with higher disease literacy, and those with professional and family support were also more likely to adhere to their medication treatment plans.
Healthcare professionals shouldn’t assume adherence
As a result of the University of Manchester study, Wadsworth is encouraging arthritis patients to develop a better understanding of the potential benefits and side effects of their medication.
According to senior author and director of the NIHR Manchester Musculoskeletal Biomedical Research Unit, Professor Ian Bruce:
This is one of the first studies to assess biological adherence in rheumatoid arthritis patients over time. In the era of new and effective high-cost drugs there is the assumption that people with rheumatoid arthritis regularly take their medication as prescribed, but our findings challenge this assumption.
We have shown that health professionals should not assume that because biologics are effective and expensive that all patients will take these as prescribed.
Importantly we have found a number of factors and patient beliefs that help us to understand why this is happening. If we can find ways to inform, support and empower our patients better, we may also be able to improve the regularity of taking these very effective medications in this potentially disabling condition. Such an approach may be extremely cost-effective, reduce the need for further intensive treatments and reduce unnecessary wastage of expensive drugs.
Digital health leaders tackle the adherence issue
Whether it’s through SMS text reminders, patient education apps, smart packaging, or pre-packaged pill packets, you can be sure that digital health innovators are invested in finding solutions to patient adherence issues.
"Research shows that if you make it convenient for patients to take their medications," Tim Peters, founder of MyMedSchedule.com said, "then you are making large strides toward promoting adherence to medication therapy.
But motivating patients to begin and maintain treatment programs is no small task. Behavior change is hard. According to Dr. Steven Zatz, president of WebMD, which just launched a medication reminder service on Apple Watch,
One of the most significant barriers to achieving positive patient outcomes is the issue of medication non-compliance, which remains a largely unsolved problem today. We believe that the combination of WebMD's Medication Reminder on Apple Watch represents a powerful new approach to address the issue of non-compliance in a way never before possible.
Time will tell if reminders are enough to motivate patients to follow their prescribed plans for treatment. I suspect that achieving adherence will take some combination of physician and nursing input, social supports (both face-to-face and virtual), patient education, and digital health solutions.
The nuviun blog is intended to contribute to discussion and stimulate debate on important issues in global digital health. The views are solely those of the author.