Authors (including presenting author) :
Yip WY(1),Chong CH(1),Ng WL(2),Lee PF(2),Cheung YS(2)
Affiliation :
(1)Pharmacy Department, United Christian Hospital,(2)Department of Medicine and Geriatrics, United Christian Hospital
Introduction :
Arthritis can cause long term disability and other comorbidities, leading to reduced quality of life. To achieve good control of arthritis, medication adherence is one of the important factors. Previous studies showed that drug education and counseling has the highest evidence in improving medication adherence in rheumatic diseases.
Objectives :
This study aimed to evaluate the effectiveness of a multi-disciplinary care model included rheumatologists, nurses and pharmacists in improving arthritis patient’s medication adherence and disease activities in Hong Kong.
Methodology :
This was a single center open-label prospective study. Arthritis patients were recruited in the United Christian Hospital from December 2019 to April 2020 in Hong Kong. The inclusion criteria were rheumatoid arthritis (RA), ankylosing spondylitis (AS) or psoriatic arthritis (PsA) patients, on at least one oral disease-modifying antirheumatic drugs (DMARDs) or steroid, adult, understood Chinese or English with no cognitive defects. Disease education was provided to participants after rheumatologist clinic by nurses. Afterwards, medication education was provided to participants by pharmacists and followed up at week 12. The primary outcome was the improvement in medication adherence which was assessed by the Compliance Questionnaire on Rheumatology (CQR-19). Secondary outcomes were improvement in disease activities and their association with medication adherence.
Result & Outcome :
55 patients (N=55) were recruited and completed the CQR-19 questionnaire at baseline and week-12 follow up. CQR-19 score greater than 80 was regarded as adherence. At baseline, only two patients (3.64%) scored greater than 80. The mean CQR-19 score was 65.0 (SD: 7.79; CI: 62.9-67.0). At follow up, the mean CQR-19 score increased to 80.5 (SD: 8.74; CI: 78.2-82.8) and the number of patients scored greater than 80 was 36 (65.5%). There was statistically significant improvement in mean CQR-19 score (P-value < 0.001) and the number of patients in the adherence group (P-value< 0.001). When comparing the adherence and non-adherence group patients at follow up, patients with intermediate education level, longer disease duration and habit of using herbal medicine were more prone to medication non-compliance.
Majority of patients (N=33) with documented disease activities were included in the analysis of improvement in disease activities using DAS-28 score. At baseline, the mean DAS-28 score was 4.40 (SD: 1.52; CI: 3.88-4.92) and it was reduced to 3.62 (SD: 1.04; CI: 3.26-3.97) at follow up. The reduction in DAS-28 score was statistically significant. (P< 0.001) However, the association between the improvement in CQR-19 and DAS-28 score was insignificant (R: -0.061; P-value=0.72). Due to limited recruitment of AS and PsA patients, improvement in their disease activity was not analysed.
A multi-disciplinary care model results in a statistically significant improvement in medication adherence and disease activities but no significant association could be shown between the two. Future randomized controlled trials are necessary to provide stronger evidence in promoting the development of multi-disciplinary care in rheumatology.
