What motivates RA patients to increase care?

Research presented by investigators at WMR at the American College of Rheumatology National Scientific Meeting in Washington, DC.

Background:

The prescription of Disease Modifying Anti-rheumatic Drugs (DMARD) for patients with rheumatoid arthritis (RA) is considered a standard of effective care.

  • However only 63% of US Medicare managed care and 43% Canadian provincial RA patients take a DMARD.
  • The explanation for underutilization is not fully known.

Methods: 

A single center, randomized controlled factorial design cross-sectional mail survey of RA patients in a large regional-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: 

Of 1538 RA patients, 1009 or 71% completed the study.  Regression modeling evaluated predictors of risk perception and willingness to take the proposed medication.

Conclusions:

  • Risk Perception was predicted by negative RA disease and treatment experience.
  • Willingness to take a proposed DMARD was predicted by current satisfaction with disease control.
  • Race and sex did not predict risk perception or DMARD willingness.
  • Depression did not predict risk perception or DMARD willingness.
  • Health literacy, independent of low education or demographics, was a common predictor of both risk perception and or DMARD willingness.

Main take home point:  

Cognitive bias, related to low health literacy, is a recognizable patient trait that may contribute to underutilization of DMARDs, and can potentially be accommodated with patient decision support

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