Determinants of treatment adherence in ethnically diverse, economically disadvantaged patients with rheumatic disease.
OBJECTIVE
To explore the determinants of adherence to medical recommendations, including drug therapy and appointment-keeping, among ethnically diverse and economically disadvantaged patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).


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.


CONCLUSIONS
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.
Garcia Popa-Lisseanu
Maria G
MG
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Greisinger
Anthony
A
Richardson
Marsha
M
O'Malley
Kimberly J
KJ
Janssen
Namieta M
NM
Marcus
Donald M
DM
Tagore
Jasmeet
J
Suarez-Almazor
Maria E
ME
D000328:Adult; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use*; D001071:Appointments and Schedules; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics / Q000208:ethnology; D003144:Communication Barriers; D018864:Cultural Diversity; D016527:Drug Costs; D005260:Female; D017144:Focus Groups; D006801:Humans; D007802:Language; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000191:economics / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D035862:Vulnerable Populations / Q000706:statistics & numerical data*
D018501:Antirheumatic Agents