Atotal of 30%-80% of patients who have rheumatic and musculoskel- etal diseases (RMDs) are thought o not take their medications
according to their physicians’ instructions.
New research offers more comprehensive
insights into addressing adherence issues
with nonpharmacologic interventions – an
area not compre-
by EULAR until now.
“The problem of
poor adherence is
addressed in some
consider on the man-
agement of specific
health conditions or
on the role of professionals,” first author
Valentin Ritschl of the Medical University of
Vienna said in an interview. “However, all
these recommendations focus on limited as-
pects of nonadherence and do not cover the
multifaceted nature of this phenomenon.”
Mr. Ritschl and colleagues conducted an
extensive systematic literature review, the
results of which they presented to a task
force consisting of a panel of international
experts hailing from 12 different countries.
The task force included rheumatologists
and other health professionals in rheuma-
tology, as well as patient representatives.
The collaboration resulted in investigators crafting a definition of adherence inaddition to drafting four overarching principles and nine points to consider, which Mr.Ritschl presented at the congress.
They defined adherence as “... the ex-
tent to which a person’s behaviour corre-
sponds with the agreed prescription.”
The four overarching principles empha-
sise the following concepts:
• That adherence affects outcomes in
people who have RMDs.
• The importance of shared decision-mak-
ing, with the understanding that the
adherence describes the patient’s be-
haviour “... following an agreed
• That numerous factors can affect
• The notion of adherence being a dynamic process that, consequently, requirescontinuous evaluation.
Among the nine points to consider,Mr. Ritschl and coauthors encourage allhealthcare providers involved in caring forRMD patients to assume responsibility forpromoting adherence. Practitioners shouldalso strive to create an ongoing, opendialogue to discuss adherence, especiallyin cases in which the patient’s RMD isnot well controlled. The patient-centredrecommendations include taking into account the patient’s goals and preferencesbecause these greatly contribute to thepatient’s ability to adhere to any medication regimen. Another arm of that exploration also requires the medical professionalto evaluate any circumstances that couldbear a negative effect on the patient’sadherence – whether it be medication access issues related to cost or availability,or functional challenges such as memory,motivation, or complexity of the medication regimen.
Mr. Ritschl believes his team’s study will
add value and help improve overall out-
comes in RMD population management.
“Until today, there are no recommendations or points to consider developed in order to support our patients to be adherentto the agreed treatment plan,” he said. “Inour project/initiative, we therefore developed for the first time points to consider todetect, assess, and manage nonadherencein people with RMDs.”
Additionally, the study offers some strategic insights to help improve clinical trialsbecause the deleterious effects of nonadherence also affect study results.
Looking ahead, Mr. Ritschl said randomised, controlled trials are necessary totest strategies that might improve adherence. He strongly emphasised the importance of designing future research studiesthat are heavily patient-centred and effective for shared decision-making.
The project was funded by EULAR. Mr.Ritschl reported having no disclosures,but many of his coauthors reported financial relationships with pharmaceuticalcompanies.
EULAR recommendations define strategies
to improve adherence in RMDs