Non-adherence in difficult-to-treat rheumatoid arthritis from the perspectives of patients and rheumatologists: a concept mapping study

N. M. T. Roodenrijs; M. C. van der Goes; P.M.J. Welsing; E. P. C.  van Oorschot; E. Nikiphorou; N. C. Nijhof; J. Tekstra; F.P.J.G.  Lafeber; J.W.G. Jacobs; J.M. van Laar; R. Geenen

doi:10.1093/rheumatology/keab130

Non-adherence in difficult-to-treat rheumatoid arthritis from the perspectives of patients and rheumatologists: a concept mapping study

N. M. T. Roodenrijs^*, M. C. van der Goes, P.M.J. Welsing, E. P. C. van Oorschot, E. Nikiphorou, N. C. Nijhof, J. Tekstra, F.P.J.G. Lafeber, J.W.G. Jacobs, J.M. van Laar, R. Geenen

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objectives

Treatment non-adherence is more frequent among difficult-to-treat (D2T) than among non-D2T RA patients. Perceptions of non-adherence may differ. We aimed to thematically structure and prioritize barriers to (i.e. causes and reasons for non-adherence) and facilitators of optimal adherence from the patients’ and rheumatologists’ perspectives.

Methods

Patients’ perceptions were identified in semi-structured in-depth interviews. Experts selected representative statements regarding 40 barriers and 40 facilitators. Twenty D2T and 20 non-D2T RA patients sorted these statements during two card-sorting tasks: first, by order of content similarity and, second, content applicability. Additionally, 20 rheumatologists sorted the statements by order of content applicability to the general RA population. The similarity sorting was used as input for hierarchical cluster analysis. The applicability sorting was analysed using descriptive statistics, prioritized and the results compared between D2T RA patients, non-D2T RA patients and rheumatologists.

Results

Nine clusters of barriers were identified, related to the healthcare system, treatment safety/efficacy, treatment regimen and patient behaviour. D2T RA patients prioritized adverse events and doubts about effectiveness as the most important barriers. Doubts about effectiveness were more important to D2T than to non-D2T RA patients (P = 0.02). Seven clusters of facilitators were identified, related to the healthcare system and directly to the patient. All RA patients and rheumatologists prioritized a good relationship with the healthcare professional and treatment information as the most helpful facilitators.

Conclusions

D2T RA patients, non-D2T RA patients and rheumatologists prioritized perceptions of non-adherence largely similarly. The structured overviews of barriers and facilitators provided in this study may guide improvement of adherence.

Original language	English
Pages (from-to)	5105-5116
Number of pages	12
Journal	Rheumatology (Oxford, England)
Volume	60
Issue number	11
Early online date	2021
DOIs	https://doi.org/10.1093/rheumatology/keab130
Publication status	Published - 3 Nov 2021

Bibliographical note

Publisher Copyright:
© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: [email protected].

Keywords

difficult-to-treat
patients’
perspective
rheumatoid arthritis
rheumatologists’
treatment non-adherence

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10.1093/rheumatology/keab130

keab130Final published version, 438 KBLicence: Taverne

Cite this

Roodenrijs, N. M. T., van der Goes, M. C., Welsing, P. M. J., van Oorschot, E. P. C., Nikiphorou, E., Nijhof, N. C., Tekstra, J., Lafeber, F. P. J. G., Jacobs, J. W. G., van Laar, J. M., & Geenen, R. (2021). Non-adherence in difficult-to-treat rheumatoid arthritis from the perspectives of patients and rheumatologists: a concept mapping study. Rheumatology (Oxford, England), 60(11), 5105-5116. https://doi.org/10.1093/rheumatology/keab130

@article{64a901398998466e814e046ca9160070,

title = "Non-adherence in difficult-to-treat rheumatoid arthritis from the perspectives of patients and rheumatologists: a concept mapping study",

abstract = "ObjectivesTreatment non-adherence is more frequent among difficult-to-treat (D2T) than among non-D2T RA patients. Perceptions of non-adherence may differ. We aimed to thematically structure and prioritize barriers to (i.e. causes and reasons for non-adherence) and facilitators of optimal adherence from the patients{\textquoteright} and rheumatologists{\textquoteright} perspectives.MethodsPatients{\textquoteright} perceptions were identified in semi-structured in-depth interviews. Experts selected representative statements regarding 40 barriers and 40 facilitators. Twenty D2T and 20 non-D2T RA patients sorted these statements during two card-sorting tasks: first, by order of content similarity and, second, content applicability. Additionally, 20 rheumatologists sorted the statements by order of content applicability to the general RA population. The similarity sorting was used as input for hierarchical cluster analysis. The applicability sorting was analysed using descriptive statistics, prioritized and the results compared between D2T RA patients, non-D2T RA patients and rheumatologists.ResultsNine clusters of barriers were identified, related to the healthcare system, treatment safety/efficacy, treatment regimen and patient behaviour. D2T RA patients prioritized adverse events and doubts about effectiveness as the most important barriers. Doubts about effectiveness were more important to D2T than to non-D2T RA patients (P = 0.02). Seven clusters of facilitators were identified, related to the healthcare system and directly to the patient. All RA patients and rheumatologists prioritized a good relationship with the healthcare professional and treatment information as the most helpful facilitators.ConclusionsD2T RA patients, non-D2T RA patients and rheumatologists prioritized perceptions of non-adherence largely similarly. The structured overviews of barriers and facilitators provided in this study may guide improvement of adherence.",

keywords = "difficult-to-treat, patients{\textquoteright}, perspective, rheumatoid arthritis, rheumatologists{\textquoteright}, treatment non-adherence",

author = "Roodenrijs, {N. M. T.} and {van der Goes}, {M. C.} and P.M.J. Welsing and {van Oorschot}, {E. P. C.} and E. Nikiphorou and Nijhof, {N. C.} and J. Tekstra and F.P.J.G. Lafeber and J.W.G. Jacobs and {van Laar}, J.M. and R. Geenen",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: [email protected].",

year = "2021",

month = nov,

day = "3",

doi = "10.1093/rheumatology/keab130",

language = "English",

volume = "60",

pages = "5105--5116",

journal = "Rheumatology (Oxford, England)",

issn = "1462-0324",

publisher = "Oxford University Press",

number = "11",

}

Roodenrijs, NMT, van der Goes, MC, Welsing, PMJ, van Oorschot, EPC, Nikiphorou, E, Nijhof, NC, Tekstra, J, Lafeber, FPJG, Jacobs, JWG, van Laar, JM & Geenen, R 2021, 'Non-adherence in difficult-to-treat rheumatoid arthritis from the perspectives of patients and rheumatologists: a concept mapping study', Rheumatology (Oxford, England), vol. 60, no. 11, pp. 5105-5116. https://doi.org/10.1093/rheumatology/keab130

TY - JOUR

T1 - Non-adherence in difficult-to-treat rheumatoid arthritis from the perspectives of patients and rheumatologists

T2 - a concept mapping study

AU - Roodenrijs, N. M. T.

AU - van der Goes, M. C.

AU - Welsing, P.M.J.

AU - van Oorschot, E. P. C.

AU - Nikiphorou, E.

AU - Nijhof, N. C.

AU - Tekstra, J.

AU - Lafeber, F.P.J.G.

AU - Jacobs, J.W.G.

AU - van Laar, J.M.

AU - Geenen, R.

N1 - Publisher Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: [email protected].

PY - 2021/11/3

Y1 - 2021/11/3

N2 - ObjectivesTreatment non-adherence is more frequent among difficult-to-treat (D2T) than among non-D2T RA patients. Perceptions of non-adherence may differ. We aimed to thematically structure and prioritize barriers to (i.e. causes and reasons for non-adherence) and facilitators of optimal adherence from the patients’ and rheumatologists’ perspectives.MethodsPatients’ perceptions were identified in semi-structured in-depth interviews. Experts selected representative statements regarding 40 barriers and 40 facilitators. Twenty D2T and 20 non-D2T RA patients sorted these statements during two card-sorting tasks: first, by order of content similarity and, second, content applicability. Additionally, 20 rheumatologists sorted the statements by order of content applicability to the general RA population. The similarity sorting was used as input for hierarchical cluster analysis. The applicability sorting was analysed using descriptive statistics, prioritized and the results compared between D2T RA patients, non-D2T RA patients and rheumatologists.ResultsNine clusters of barriers were identified, related to the healthcare system, treatment safety/efficacy, treatment regimen and patient behaviour. D2T RA patients prioritized adverse events and doubts about effectiveness as the most important barriers. Doubts about effectiveness were more important to D2T than to non-D2T RA patients (P = 0.02). Seven clusters of facilitators were identified, related to the healthcare system and directly to the patient. All RA patients and rheumatologists prioritized a good relationship with the healthcare professional and treatment information as the most helpful facilitators.ConclusionsD2T RA patients, non-D2T RA patients and rheumatologists prioritized perceptions of non-adherence largely similarly. The structured overviews of barriers and facilitators provided in this study may guide improvement of adherence.

AB - ObjectivesTreatment non-adherence is more frequent among difficult-to-treat (D2T) than among non-D2T RA patients. Perceptions of non-adherence may differ. We aimed to thematically structure and prioritize barriers to (i.e. causes and reasons for non-adherence) and facilitators of optimal adherence from the patients’ and rheumatologists’ perspectives.MethodsPatients’ perceptions were identified in semi-structured in-depth interviews. Experts selected representative statements regarding 40 barriers and 40 facilitators. Twenty D2T and 20 non-D2T RA patients sorted these statements during two card-sorting tasks: first, by order of content similarity and, second, content applicability. Additionally, 20 rheumatologists sorted the statements by order of content applicability to the general RA population. The similarity sorting was used as input for hierarchical cluster analysis. The applicability sorting was analysed using descriptive statistics, prioritized and the results compared between D2T RA patients, non-D2T RA patients and rheumatologists.ResultsNine clusters of barriers were identified, related to the healthcare system, treatment safety/efficacy, treatment regimen and patient behaviour. D2T RA patients prioritized adverse events and doubts about effectiveness as the most important barriers. Doubts about effectiveness were more important to D2T than to non-D2T RA patients (P = 0.02). Seven clusters of facilitators were identified, related to the healthcare system and directly to the patient. All RA patients and rheumatologists prioritized a good relationship with the healthcare professional and treatment information as the most helpful facilitators.ConclusionsD2T RA patients, non-D2T RA patients and rheumatologists prioritized perceptions of non-adherence largely similarly. The structured overviews of barriers and facilitators provided in this study may guide improvement of adherence.

KW - difficult-to-treat

KW - patients’

KW - perspective

KW - rheumatoid arthritis

KW - rheumatologists’

KW - treatment non-adherence

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U2 - 10.1093/rheumatology/keab130

DO - 10.1093/rheumatology/keab130

M3 - Article

SN - 1462-0324

VL - 60

SP - 5105

EP - 5116

JO - Rheumatology (Oxford, England)

JF - Rheumatology (Oxford, England)

IS - 11

ER -

Non-adherence in difficult-to-treat rheumatoid arthritis from the perspectives of patients and rheumatologists: a concept mapping study

Abstract

Bibliographical note

Keywords

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