Prevention, Screening, Assessing and Managing of Non-adherent Behaviour in People with Rheumatic and Musculoskeletal Diseases: Systematic Reviews Informing the 2020 EULAR Points to Consider

Overview

Journal RMD Open

Publisher BMJ Publishing Group

Specialty Rheumatology

Date 2020 Nov 8

PMID 33161377

Citations 12

Authors

Valentin Ritschl

Tanja A Stamm

Daniel Aletaha

Johannes W J Bijlsma

Peter Bohm

Razvan Dragoi

Emma Dures

Fernando Estevez-Lopez

Laure Gossec

Annamaria Iagnocco

Jose B Negron

Michal Nudel

Andrea Marques

Ellen Moholt

Conni Skrubbeltrang

Bart van den Bemt

Kirsten Viktil

Marieke Voshaar

Loreto Carmona

Annette de Thurah

Affiliations

Soon will be listed here.

Abstract

Objective: To analyse how non-adherence to prescribed treatments might be prevented, screened, assessed and managed in people with rheumatic and musculoskeletal diseases (RMDs).

Methods: An overview of systematic reviews (SR) was performed in four bibliographic databases. Research questions focused on: (1) effective interventions or strategies, (2) associated factors, (3) impact of shared decision making and effective communication, (4) practical things to prevent non-adherence, (5) effect of non-adherence on outcome, (6) screening and assessment tools and (7) responsible healthcare providers. The methodological quality of the reviews was assessed using AMSTAR-2. The qualitative synthesis focused on results and on the level of evidence attained from the studies included in the reviews.

Results: After reviewing 9908 titles, the overview included 38 SR on medication, 29 on non-pharmacological interventions and 28 on assessment. Content and quality of the included SR was very heterogeneous. The number of factors that may influence adherence exceed 700. Among 53 intervention studies, 54.7% showed a small statistically significant effect on adherence, and all three multicomponent interventions, including different modes of patient education and delivered by a variety of healthcare providers, showed a positive result in adherence to medication. No single assessment provided a comprehensive measure of adherence to either medication or exercise.

Conclusions: The results underscore the complexity of non-adherence, its changing pattern and dependence on multi-level factors, the need to involve all stakeholders in all steps, the absence of a gold standard for screening and the requirement of multi-component interventions to manage it.

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