Expert Perspectives: Improved Medication Adherence in Rheumatic Diseases

“Our study confirms challenges in selecting an appropriate outcome in interventional studies targeting medication adherence and the ways in which the lack of guidance in this area hinders research and limits our ability to compare interventions and draw conclusions about their effectiveness,” stated investigators.

Investigators identified 3 overarching themes that will allow for improved medication adherence research and created a comprehensive list of recommendations, according to a study published in BMC Rheumatology.1 Investigator-informed recommendations included specifying the targeted adherence phase when designing future studies, developing a core domain set for international studies, and utilizing a glossary of terms to ensure consistency.

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Medication non-adherence in rheumatic diseases can be as high as 90% in patients with gout, 70% in patients with rheumatoid arthritis (RA), and 43% in patients with systemic lupus erythematosus (SLE).

“Our study confirms challenges in selecting an appropriate outcome in interventional studies targeting medication adherence and the ways in which the lack of guidance in this area hinders research and limits our ability to compare interventions and draw conclusions about their effectiveness,” stated investigators.

Investigators at the Outcome Measures in Rheumatology (OMERACT) Adherence Working Group conducted audio conference interviews with a small sample of professionals who had experience in medication adherence research (clinical trials, observational studies, etc). Participants were recruited from collegial and professional networks internationally. Purposive sampling was used to collect an array of perspectives and ensure variation regarding demographic characteristics, expertise, and research discipline.

Using interview transcripts, categories and themes were analyzed until investigators reached saturation, which was defined as the point when no new insights emerged. Afterwards, results were shown to participants to ensure the accuracy of their perspectives. Quotes were also provided.

A total of 13 (8 males, 5 females) researchers from 7 countries (Australia, Belgium, Canada, Netherland, Thailand, United Kingdom, and United States of America) participated in the study. All held a doctoral level degree and led between 2 and 5 adherence research studies in recent years. Most (75%) worked in academia.

Three themes emerged: improving measurement of adherence, challenges faced when designing and appraising adherence intervention studies, and advancing the outcome assessment within these studies.

Strengths included the collaborative effort of the interview guide with Working Group members, purposive sampling for diversity of perspectives, investigator triangulation, and member checking. Limitations of the study were only interviewing English-speaking researchers and soley focusing on adherence of patients with rheumatic diseases. However, as these issues are not exclusive to rheumatology, investigators believe the findings may be applied to all adherence intervention research.

“Overall, adherence intervention research in rheumatology has been hindered by lack of standardization and guidance on terminology, measurement and outcome selection,” concluded investigators. “Our study forms the basis for recommendations for improving the design, conduct and evaluation of adherence intervention studies in rheumatology, particularly for developing a core domain set of outcomes to improve consistency and facilitate comparisons.”

Reference:

Salmasi S, Kelly A, Bartlett SJ, et al. Researchers' perspectives on methodological challenges and outcomes selection in interventional studies targeting medication adherence in rheumatic diseases: an OMERACT-adherence study. BMC Rheumatol. 2021;5(1):26. Published 2021 Jul 8. doi:10.1186/s41927-021-00193-4