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Can Patient Navigators Improve Adherence to Disease‐Modifying Antirheumatic Drugs? Quantitative Findings From a Six‐Month Single‐Arm Pilot Intervention
Author(s) -
Feldman Candace H.,
Wohlfahrt Alyssa,
Campos Anarosa,
Gagne Joshua J.,
Iversen Maura D.,
Massarotti Elena,
Solomon Daniel H.,
Kawachi Ichiro
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23302
Subject(s) - medicine , physical therapy , adverse effect , intervention (counseling) , motivational interviewing , randomized controlled trial , psychiatry
Objective Nonadherence to disease‐modifying antirheumatic drugs ( DMARD s) is common, worsens during the treatment course, and results in adverse outcomes. We studied whether patient navigators (laypersons trained in care coordination, motivational interviewing, basic pharmacology, and disease management) improved oral DMARD adherence. Methods We enrolled 107 patients ages ≥18 years with systemic rheumatic diseases who initiated an oral DMARD within 6 months. Navigators interacted with patients up to 2–4 times per week for 6 months. Patients completed validated surveys (Morisky Medication Adherence Scale [ MMAS ‐8], Mental Health Inventory [ MHI ‐5], Beliefs about Medicines Questionnaire, and Brief Illness Perception Questionnaire) at baseline and at 6 months. We used paired t ‐tests to compare baseline and 6‐month outcomes. We examined the association of age, race/ethnicity, insurance, and MHI ‐5 with change in MMAS ‐8 score using multivariable linear regression. Results Among 107 patients enrolled, 69 (64%) completed baseline and 6‐month MMAS ‐8 surveys. Mean ± SD age was 55 ± 16 years and 93% were female. The mean ± SD baseline MMAS ‐8 score was 6.7 ± 1.3 (indicating borderline adherence), and the mean ± SD MHI ‐5 score was 60.8 ± 9.1 (<68 suggests any depressive symptoms). After 6 months, there were no significant changes in MMAS ‐8 ( P = 0.09) or MHI ‐5 ( P = 0.83). Patients described fewer medication concerns ( P = 0.03), but a more threatening perception of illness ( P = 0.01). Our multivariable model demonstrated a small change in MMAS ‐8 for each 5‐year increase in age (β = 0.14, P = 0.02). Conclusion Our intervention resulted in no significant change in adherence from baseline. A multicenter, randomized controlled trial is needed to determine whether patient navigators are effective in maintaining adherence to DMARD s over time.