Can patient navigators improve adherence to disease-modifying anti-rheumatic drugs? Quantitative findings from the med assist pilot study

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Can patient navigators improve adherence to disease-modifying anti-rheumatic drugs? Quantitative findings from the med assist pilot study
Key Take-Away: 

Rheumatoid arthritis is a debilitating condition managed by a class of medications, known as disease-modifying antirheumatic drugs (DMARDs). However, patients show non-adherence toward DMARDs during the treatment. This study predicts the role of patient navigators in decreasing the non-adherence towards DMARDs and establish the need for further research in this context.

Non-adherence to DMARDs is common, worsens during the treatment course, and results in adverse outcomes.

ABSTRACT: 
Background: 

Non-adherence to DMARDs is common, worsens during the treatment course, and results in adverse outcomes.

The investigators studied whether patient navigators – laypersons trained in care coordination, motivational interviewing, basic pharmacology and disease management- improved oral DMARD adherence.

Methods: 

A total of 107 patients aged ≥18 years with systemic rheumatic diseases who initiated an oral DMARD within 6 months were enrolled. Navigators interacted with patients up to 2-4 times per week for 6 months.

Patients completed validated surveys (Morisky Medication Adherence Scale (MMAS-8), Mental Health Inventory (MHI-5), Beliefs about Medicines Questionnaire and Brief Illness Perception Questionnaire) at baseline and at 6 months. The paired t-tests were used to compare baseline and 6-month outcomes. The association of age, race/ethnicity, insurance and MHI-5 with a change in MMAS-8 score was examined using multivariable linear regression.

Results: 

Among 107 patients enrolled, 69 (64%) completed baseline and 6-month MMAS-8 surveys. Mean age was 55 ±16 years; 93% were female.

The mean baseline MMAS-8 score was 6.7 ±1.3 (indicating borderline adherence), and the mean MHI-5 was 60.8 ± 9.1(<68 suggests any depressive symptoms). After 6 months, there were no significant changes in MMAS-8 (p=0.09) or MHI-5 (p=0.83). Patients described fewer medication concerns (p=0.03), but a more threatening perception of illness (p=0.01). The multivariable model demonstrated a small change in MMAS-8 for each 5-year increase in age (β=0.14, p=0.02).

Conclusion: 

Study intervention resulted in no significant change in adherence from baseline.

A multicenter, randomized controlled trial is needed to determine whether patient navigators are effective in maintaining adherence to DMARDs over time. 

Arthritis Care & Research
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