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Patient's relationship with rheumatologist affects perception of medication
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The nature of the relationship that patients with systemic autoimmune rheumatic diseases have with their rheumatologist can greatly affect perceptions of — and experiences with — their medications, according to findings published in BMC Rheumatology.
“The importance of this study is that we have done a systematic search and identification of qualitative studies exploring views on medication use among patients with [systemic autoimmune rheumatic diseases (SARDs)],” Mary A. De Vera, PhD, of the University of British Columbia and Arthritis Research Canada, Vancouver, told Healio Rheumatology. “By synthesizing findings across these studies — including 40 studies involving 1,522 SARD patients — this study provides a comprehensive understanding of patients’ perspectives.”
To help determine how to better support medication use among patients with SARDs, the researchers conducted both systematically reviewed and thematically synthesized qualitative research studies detailing individuals’ perceptions and experiences.
Using MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Social Sciences Citation Index databases, De Vera and colleagues focused on articles that expressed the views patients with SARDs reported on medication use, health care providers and other caregivers. The researchers included 18 studies in their systematic review, and 40 studies, comprising 1,522 patients, for the thematic synthesis.
According to the researchers, the thematic synthesis identified seven analytical themes related to the perceptions and experiences of patients with SARDS: effects of medications on emotional and social well-being, impacts of health care provider relationships on treatment, gaining control over treatment, fear and concern related to treatment side effects, understanding the importance of treatment, practical barriers to taking medication and motivation for treatment adherence.
De Vera and colleagues found that medications negatively impacted patients’ emotional and social well-being, with individuals often worrying that the drugs would hinder their sexual lives or ability to have a child. In addition, medication side effects also contributed to negative impacts, such as being bullied at school or an aversion to social interactions due to weight gain. However, the researchers also found that patients often reported that their relationship with their rheumatologist directly affected their perceptions and experiences related to taking medication. Patients also expressed that they valued relationships with allied health care providers, including nurses and pharmacists.
“These results really touch on how complex medication taking is,” De Vera said. “A key clinical implication is the importance patients placed on health care provider relationships, particularly with their rheumatologists, but also highlighting the roles of allied health care professionals including nurses and pharmacists.”
De Vera added it was important to assess the perspectives of a variety of patients across several SARDs conditions.
“Another key thing about our study is that, to our knowledge, it is the first that has combined perspectives across different SARDs, and while there are many differences across these conditions, they also share similarities, including treatments,” she said. “Grouping them together has implications for representing types of SARDs which may have been less represented in prior research on medication taking.” – by Jason Laday
Disclosure: De Vera reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Carrie Beach, BSN, RN
The review conducted by Haag and colleagues highlights the importance of the rheumatology health care provider role with regard to improving medication adherence rates among patients with SARDs. The studies reviewed in this article indicate suboptimal medication adherence rates among patients diagnosed with SARDs and indicate that there are very few interventions that are aimed at increasing adherence.
The seven themes identified regarding adherence reflect a significant part of my role as a rheumatology nurse. Not surprisingly, patients often remarked that the relationship with the rheumatology provider impacted adherence: Those with good relationships had higher rates of adherence; those that did not feel that they were being listened to or valued as a patient were more likely to discontinue medications.
What is important to remember is that “adherence” goes far beyond taking medications. These patients need to understand their disease process, the importance of taking these medications, and how these medications work to manage their disease. Pharmacotherapy is essential to managing our patients’ disease, but I think this article reveals that the greater importance is the patient/provider relationship. With few interventions identified to improve adherence among patients with SARDs, taking the time to build a strong rapport and educate patients is essential to improving patient outcomes.
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