Influence of patient characteristics on perceived risks and willingness to take a proposed anti-rheumatic drug.
BACKGROUND
The causes of the underutilization of disease modifying anti-rheumatic drugs (DMARDS) for rheumatoid arthritis (RA) are not fully known, but may in part, relate to individual patient factors including risk perception. Our objective was to identify the determinants of risk perception (RP) in RA patients and predictors of their willingness to take a proposed DMARD (DMARD willingness).


METHODS
A cross-sectional mail survey of RA patients in a community rheumatology practice. Patients were presented a hypothetical decision scenario where they were asked to consider switching DMARDs. They evaluated how risky the proposed medication was and how likely they would be to take it.


RESULTS
The completed sample included 1009 RA patients. The overall survey response rate was 71%.


METHODS
age 61.6 years (range 18-93), 75% female, minority 6.5%, low or marginal health literacy 8.8%, depression 15.0%, duration RA 13.1 years (range 0.5 - 68). Regression models demonstrated that health literacy, independent of low educational achievement or other demographic (including race), was a common predictor of both RP and DMARD willingness. There was partial mediation of the effects of HL on DMARD willingness through RP. Depression and happiness had no significant effect on RP or DMARD willingness. RP was influenced by negative RA disease and treatment experience, while DMARD willingness was affected mainly by perceived disease control.


CONCLUSIONS
Risk aversion may be the result of potentially recognizable and correctable cognitive defect. Heightened clinician awareness, formal screening for low health literacy or cognitive impairment in high-risk populations, may identify patients could benefit from additional decision support.
Department of Medicine, Rheumatology, Michigan State University, College of Human Medicine Grand Rapids, Grand Rapids, MI 49546, USA. martin@mi-arthritis.com
Richard W
RW
Martin
Kelsey
K
McCallops
Andrew J
AJ
Head
Aaron T
AT
Eggebeen
James D
JD
Birmingham
Donald J
DJ
Tellinghuisen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000145:classification / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D003657:Decision Making; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008484:Medicaid; D008824:Michigan; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology* / Q000706:statistics & numerical data; D012307:Risk Factors; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
D018501:Antirheumatic Agents