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Association of Medication Beliefs, Self-efficacy, and Adherence in a Diverse Cohort of Adults with Rheumatoid Arthritis

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McCulley C1, Katz P1, Trupin L1, Yelin EH1, Barton JL1. J Rheumatol. 2018 Sep 15. pii: jrheum.171339. doi: 10.3899/jrheum.171339. [Epub ahead of print]

Abstract

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1 From the University of California, San Francisco, San Francisco, California; Oregon Health & Science University; VA Portland Health Care System, Portland, Oregon, USA. P. Katz received funding from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Multidisciplinary Clinical Research Center [US National Institutes of Health (NIH): P60AR053308]. E.H. Yelin received funding from NIAMS Multidisciplinary Clinical Research Center (NIH: P60AR053308). J.L. Barton received funding from NIH/NIAMS (K23-AR-064372). C. McCulley, MD, Rheumatology Fellow, Oregon Health & Science University; P. Katz, PhD, Professor, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Epidemiologist, Division of Rheumatology, University of California, San Francisco; E.H. Yelin, PhD, Professor Emeritus, Division of Rheumatology, University of California, San Francisco, J.L. Barton, MD, Associate Professor, Division of Rheumatology, Oregon Health & Science University, and VA Portland Health Care System. Address correspondence to Dr. J.L. Barton, Oregon Health & Science University, Rheumatology, 3181 SW Sam Jackson Park Road, Mail Code: OP09, Portland, Oregon 97239, USA. E-mail: bartoje@ohsu.edu. Accepted for publication June 25, 2018.

Abstract

OBJECTIVE: Rheumatoid arthritis (RA) patients' adherence to disease-modifying antirheumatic drugs (DMARD) is often suboptimal. We examined associations among medication beliefs, self-efficacy, and adherence to medications in RA.

METHODS: Data were from a longitudinal observational cohort of persons with RA. Subjects completed telephone interviews on self-reported adherence, self-efficacy, demographics, and the Beliefs about Medicines Questionnaire (BMQ), which assesses beliefs in necessity and beliefs about taking medication. Bivariate and multivariate logistic regression identified correlates of poor adherence to synthetic DMARD and prednisone as well as to biologic therapy, including medication concerns and necessity.

RESULTS: There were 362 patients who reported taking a synthetic DMARD and/or prednisone. Of these, 14% and 21% reported poor adherence to oral DMARD or prednisone, and biologics, respectively. There were 64% who reported concern about taking medicines, 81% about longterm effects, and 47% about becoming too dependent on medicines. In multivariate analyses, the BMQ necessity score was independently associated with better adherence to oral DMARD or prednisone (adjusted OR 0.61, 95% CI 0.41-0.91), while self-efficacy was associated with greater odds of poor adherence to oral medications (adjusted OR 1.23, 95% CI 1.01-1.59). Beliefs in medicines and self-efficacy were not associated with adherence to biologics.

CONCLUSION: In a diverse cohort of patients with RA, stronger beliefs in the necessity of medication were associated with better adherence to oral DMARD or prednisone, while higher self-efficacy was associated with poor adherence. Providers can play important roles in eliciting patient beliefs about medications to improve adherence and ultimately health outcomes.