title: Limited end-user knowledge of methotrexate despite patient education: an assessment of rheumatologic preventive practice and effectiveness.
abstract: BACKGROUND
  Methotrexate (MTX) is a first-line disease-modifying agent and anchor drug for biologic therapy used in rheumatoid arthritis and other inflammatory rheumatic disorders. Adverse effects are a common cause of drug discontinuation and include preventable serious incidents that may result in patient harm or death.
  
  
  OBJECTIVE
  The objective of this study was to audit adherence by health professionals to national and international guidelines for patient education and risk reduction in patients prescribed MTX for inflammatory rheumatic diseases.
  
  
  METHODS
  A combination of interviews, case record reviews, and self-administered patient knowledge questionnaires with individual patient feedback was used. The setting was the rheumatology outpatient department of a district general hospital.
  
  
  RESULTS
  Fifty-one patients participated in the audit. The mean age was 58.6 (SD, 13.1) years and median duration of disease was 3.7 years (interquartile range, 1.7-7.6 years). Nurse-led patient education was documented at baseline for 94.1% of participants. Despite this, only 11.8% of participants recognized the potentially lethal drug-drug interaction with trimethoprim/Septrin (co-trimoxazole), and less than 60.8% recognized possible major adverse effects related to MTX. Although lifestyle implications relating to alcohol consumption and pregnancy/breast-feeding were recognized by the majority, only 52.9% of males were aware of recommendations in relation to conception. Univariable and multivariable analyses identified male sex, not speaking English as a first language, and a longer duration of therapy as predictors of lower levels of patient knowledge.
  
  
  CONCLUSIONS
  Despite consistent baseline patient education, end-user knowledge and awareness pertinent to MTX safety are limited. Good-quality written information in the most appropriate language, patient feedback on educational programs, follow-up testing of patient knowledge, and targeted reeducation are recommended to address individual deficiencies in core knowledge.
authors.affiliation: Department of Rheumatology, Royal Blackburn Hospital, Blackburn, United Kingdom. evinsowden@nhs.net
authors.forename: Evin
authors.initials: E
authors.lastname: Sowden
authors.forename: Wajid
authors.initials: W
authors.lastname: Hassan
authors.forename: Ann
authors.initials: A
authors.lastname: Gooden
authors.forename: Bridget
authors.initials: B
authors.lastname: Jepson
authors.forename: Tamsheela
authors.initials: T
authors.lastname: Kausor
authors.forename: Ifraz
authors.initials: I
authors.lastname: Shafait
authors.forename: Sahena
authors.initials: S
authors.lastname: Haque
authors.forename: John E
authors.initials: JE
authors.lastname: Brockbank
authors.forename: Robert W
authors.initials: RW
authors.lastname: Ley
authors.forename: Lee-Suan
authors.initials: LS
authors.lastname: Teh
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000517:prevention & control; D054869:Clinical Audit; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D008297:Male; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D010353:Patient Education as Topic; D011247:Pregnancy; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate