This article is more than 5 years old. Information may no longer be current.
Patient satisfaction ‘highly correlated’ with treatment adherence
Click Here to Manage Email Alerts
CHICAGO — Although rarely taken into account in practice guidelines, patient satisfaction remains an important factor in both treatment adherence and outcomes for psoriatic and rheumatoid arthritis, according to Jon T. Giles, MD, MPH, of the Columbia University College of Physicians and Surgeons.
“The best way to get a patient to not take a medication is for them to be unconvinced about what its effect is going to be, or for them to be concerned about safety,” Giles told attendees at the 2019 Interdisciplinary Autoimmune Summit. “There are not a lot of studies of patient satisfaction, and they are certainly not often included in our practice guidelines. Often times, studies rely on clinician-centered measures to determine how a treatment performed.”
“However, the patient does evaluate how many swollen joints they have, and what their overall disease activity is,” he added. “Despite this, there are fewer indications of what patients feel or think about their disease.”
According to Giles, patient satisfaction is “highly correlated” with both treatment adherence and outcomes, as well as responses to Health-Related Quality of Life (HRQoL) indices, including the Dermatology Life Quality Index.
This is important, Giles said, because patients who fail immunomodulator therapies typically have poorer HRQoL scores compared with patients who achieve treatment success. A low HRQoL scores have also been found to impair physical functioning, physical activity and work productivity, he added.
“When we talk about the efficacy of drugs, we tend to focus on the physical aspect, but there is a mental aspect as well,” Giles said. “Patients who are failing their medications — as opposed to those who are doing better in terms of disease activity — are one of aspects that we don’t readily measure in clinical trials, along with mental health, work productivity and fatigue.”
Other important facets that determines how patients feel about their disease and treatment are extra-articular manifestations and comorbidities, according to Giles; particularly with RA, these can affect nearly every organ in the body and potentially be life-threatening.
In addition, patients who are treated early, aggressively and effectively will often not demonstrate any such manifestations and comorbidities in remission, he added.
“If a patient has a lot of articular activity disease and a lot of comorbidities, it can affect how they feel, their fatigue, whether they can go to work, or if they are depressed — a lot of it has to do with what is outside the joint as well,” Giles said. “We have to concentrate on, evaluate and manage these factors as well.”
In PsA, unique extra-articular manifestations such as uveitis, inflammatory bowel disease and nail disease can also result in fatigue and depression comorbidities, as well as an increased risk for malignancy and infection, he added.
According to Giles, health care providers can help patients remain motivated and engaged in their care by first understanding the reasons for diminished adherence, and by maintaining an open and honest line of communication.
In particular, physicians must set realistic expectations for the patient and their disease, Giles said.
“I don’t tell patients that if they take a drug they are going to feel instantaneously better — obviously they are not,” he said. “You need to tell them that they may have to try several different things, and it may take some time, but if they keep working with you, because there are so many treatment options, the two of you will find something that works for them. Obviously, taking a health-literate approach to educating patients will also help, but building a trusting, one-on-one relationship with the patient is essential for long-term management.” – by Jason Laday
Reference:
Giles JT. A Virtual Reality Tour: New Goals of Therapy for Psoriatic and Rheumatoid Arthritis: Managing Comorbidities, Preserving Joints and Pursuing Remission with Biologics. Presented at: Interdisciplinary Autoimmune Summit; April 5-7, 2019; Chicago.
Disclosure: Giles reports consulting fees from Eli Lilly, Genentech, Horizon, BMS, UCB, Ironwood and Abbvie, as well as a research grant from Pfizer.