More than a third of patients aren't taking DMARDs as guidelines unanimously recommend. Rheumatologist Richard Martin MD reveals insights from new research about why some patients resist the idea, and what you can do to help.
Despite clear guidance on the use of disease-modifying antirheumatic drugs (DMARDs), studies show they are prescribed for only about two-thirds of patients who could be taking them. Seeking an explanation, Richard Martin MD and his coworkers launched a study that involving a very large number of patients with rheumatic disorders that investigated possible factors in a decision to refuse a DMARD.
In this brief recorded interview, he reveals that some preconceptions about the reasons for declining DMARDs are probably in error, and offers strategies for discerning which of your patients may be least difficult to persuade - and what you can do to help them agree to the best treatment.
Dr. Martin is Professor of Medicine at Michigan State University College of Human Medicine in Grand Rapids
• Your publication is written in social science terminology that’s probably unfamiliar to many rheumatologists. Can you tell us what you wanted to find out and what you learned?
• Did you find anything surprising in the results?
• What are the implications if you’re a rheumatologist considering prescribing a new DMARD?
We have a very large completed sample … demographically similar to other community practices in the United States … and probably the results are generalizable to other community rheumatology practices.
Contrary to a number of previous studies, minority status, low income, or the presence of major depression had no impact … But when we asked people about post-decision regret, that had an important impact.
We found that risk perception is mediated to a large extent by health literacy … There are simple ways to screen patients for that. Probably the simplest way is to ask patients, Do they have difficulty in using medical information on a 1 to 5 scale?
If you give people more time, they’re more likely to do the work of thinking about what are the good things and the bad things about this medication. Does it work for me?
What Holds Patients Back From Trying DMARDs
Article on which this interview is based:
Martin RW, McCallops K, Head AJ et al, Infleunce of patient characteristics on perceived risks and willingness to take a proposed anti-rheumatic drug. BMC Medical Informatics and Decision Making (2013) 13:89
Simple health literacy assessment for clinical practice:
Chew LD, Griffin JM, Partin MR, et al, Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Internal Med (2008) 23:561–566.
Online decision tools for patients:Patient Decision Aids. West Michigan Rheumatology PLLC website.
(This web page links to seprate online decision tools for patients considering methotrexate, sulfasalazine, leflunomide, anti-TNF inhibitors, abatacept, rituximab, tocilizumab, or tofacitinib.)