title: The influence of behavioural and psychological factors on medication adherence over time in rheumatoid arthritis patients: a study in the biologics era.
abstract: OBJECTIVE
  To investigate levels of self-reported adherence to biologic treatment and establish the contribution of demographic, physical and psychological factors to biologic medication adherence in an RA cohort.
  
  
  METHODS
  Adalimumab-treated patients were recruited through the British Society for Rheumatology Biologics Register for RA between May 2007 and April 2009. Demographic and baseline psychological measures including illness and medication beliefs were collected. Disease activity (28-item DAS), physical function (HAQ) and quality of life (36-item Short Form Health Survey) were also measured at baseline and at 6, 12 and 18 months. Adherence was assessed at each follow-up using the patient self-completed Compliance Questionnaire for Rheumatology (CQR). Multilevel mixed effects modelling analysis was performed to investigate predictors of adherence.
  
  
  RESULTS
  Of the 329 Adalimumab-treated patients included, low adherence (CQR score <65) was reported in 23%, with 41% reporting low adherence at at least one time point. After controlling for age and disease duration, factors independently predictive of increased adherence were increased belief in medication necessity, with baseline effect diminishing over time [β coefficient 1.68 (s.e. 0.19), P = 0.0001], lower medication concerns [0.50 (0.15), P = 0.001], with this effect remaining throughout follow-up, increased professional or family member support [0.81 (0.32), P = 0.01], strong views of illness being chronic [0.32 (0.14), P = 0.025] and increased treatment control [0.41 (0.19), P = 0.032].
  
  
  CONCLUSIONS
  Wider recognition of the importance of psychological factors, particularly medication beliefs, in driving medication adherence could have substantial clinical and health economic benefits in RA. The psychological factors we have identified are putative targets for strategies to improve adherence in RA.
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester.
authors.forename: Catharine
authors.initials: C
authors.lastname: Morgan
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, Research Institute for Primary Care & Health Sciences, Keele University, Keele.
authors.forename: John
authors.initials: J
authors.lastname: McBeth
authors.affiliation: Institute of Inflammation & Repair, University of Manchester, Manchester Academic Health Science Centre and.
authors.forename: Lis
authors.initials: L
authors.lastname: Cordingley
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester.
authors.forename: Kath
authors.initials: K
authors.lastname: Watson
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Kimme L
authors.initials: KL
authors.lastname: Hyrich
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Deborah P M
authors.initials: DP
authors.lastname: Symmons
authors.affiliation: Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK Ian.bruce@manchester.ac.uk.
authors.forename: Ian N
authors.initials: IN
authors.lastname: Bruce
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000523:psychology*; D001688:Biological Products / Q000627:therapeutic use*; D003469:Culture; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D012189:Retrospective Studies; D057566:Self Report; D012720:Severity of Illness Index; D012944:Social Support; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom
chemical_list: D001688:Biological Products; D000068879:Adalimumab
keywords: biologic therapy; epidemiology; illness perceptions; medication adherence; medication beliefs; rheumatoid arthritis