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Determinants of Treatment Adherence in Ethnically Diverse, Economically Disadvantaged Patients with Rheumatic Disease MARIA G. GARCIA POPA-LISSEANU, ANTHONY GREISINGER, MARSHA RICHARDSON, KIMBERLY J. O'MALLEY, NAMIETA M. JANSSEN, DONALD M. MARCUS, JASMEET TAGORE, and MARIA E. SUAREZ-ALMAZOR
ABSTRACT.
Methods. Patients with RA and SLE were identified through chart review and were invited to participate in focus groups to examine their attitudes and beliefs regarding adherence to treatment and medical appointments. Eight focus groups (4 RA, 4 SLE) were conducted, with a total of 40 participants (22 SLE patients and 18 RA patients). Transcripts were analyzed using grounded theory techniques and qualitative analysis software to facilitate coding interpretation. Results. The majority of participants reported experiencing difficulty in adhering to their treatment at least occasionally. Both SLE and RA patients reported similar barriers to treatment adherence: fear of side effects, financial problems, difficulty in navigating the public health system, and perceived treatment inefficacy. RA and SLE patients also revealed barriers to appointment keeping, including difficulties in scheduling, financial costs, transportation, and functional impairment limiting their ability to attend the clinic. Conclusion. Patients' perceptions of and experiences with the health system, physicians, medication effectiveness, and side effects influence their adherence to treatment and other medical recommendations. Strategies to improve adherence could include the following: attempting to modify patients' beliefs and perceptions regarding medication effectiveness, promoting realistic expectations about risk/benefit ratios, and improving access to health care by reducing barriers that limit the interaction between patients and the health system. (J Rheumatol 2005;32:913-9) Key Indexing Terms:
RHEUMATOID ARTHRITIS
From the Department of Medicine, Baylor College of Medicine; Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center; and the Kelsey Research Foundation, Houston, Texas. Supported by a grant from NIH (NIAMS), R01 AR47858 and in part by the Houston Center for Quality of Care and Utilization Studies, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. M.G. Garcia Popa-Lisseanu, MD, Department of Medicine, Baylor College of Medicine; A. Greisinger, PhD, Kelsey Research Foundation; M. Richardson, MSW; K.J. O'Malley, PhD, Department of Medicine, Baylor College of Medicine; Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center; N.M. Janssen, MD; D.M. Marcus, MD, Department of Medicine, Baylor College of Medicine; J. Tagore, BS; M.E. Suarez-Almazor, MD, MSc, PhD, Department of Medicine, Baylor College of Medicine; Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center. Address reprint requests to Dr. M.E. Suarez-Almazor, Michael E. DeBakey Veterans Affairs Medical Center (152), 2002 Holcombe Boulevard, Houston, Texas 77030, USA. E-mail: mes@bcm.tmc.edu Accepted for publication December 20, 2004. |