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Understanding Heterogeneity in Patients’ Conceptualisation of Treatment for Rheumatoid Arthritis: A Cluster Analysis

OBJECTIVE: Uptake of treat-to-target (TTT) strategies for rheumatoid arthritis (RA) management is low. Our objective was to understand the heterogeneity in patients’ conceptualisation of RA treatment to inform interventions improving TTT uptake. DESIGN: Eligible participants recruited from an online...

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Autores principales: Hsiao, Betty, Downs, Julie S, Lanyon, Mandy, Blalock, Susan J, Curtis, Jeffrey R, Harrold, Leslie R, Nowell, William Benjamin, Wiedmeyer, Carole, Venkatachalam, Shilpa, Patterson, Mark T, Gavigan, Kelly, Stradford, Laura, Ali, Danielle, Fraenkel, Liana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10481841/
https://www.ncbi.nlm.nih.gov/pubmed/37666546
http://dx.doi.org/10.1136/bmjopen-2022-070848
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author Hsiao, Betty
Downs, Julie S
Lanyon, Mandy
Blalock, Susan J
Curtis, Jeffrey R
Harrold, Leslie R
Nowell, William Benjamin
Wiedmeyer, Carole
Venkatachalam, Shilpa
Patterson, Mark T
Gavigan, Kelly
Stradford, Laura
Ali, Danielle
Fraenkel, Liana
author_facet Hsiao, Betty
Downs, Julie S
Lanyon, Mandy
Blalock, Susan J
Curtis, Jeffrey R
Harrold, Leslie R
Nowell, William Benjamin
Wiedmeyer, Carole
Venkatachalam, Shilpa
Patterson, Mark T
Gavigan, Kelly
Stradford, Laura
Ali, Danielle
Fraenkel, Liana
author_sort Hsiao, Betty
collection PubMed
description OBJECTIVE: Uptake of treat-to-target (TTT) strategies for rheumatoid arthritis (RA) management is low. Our objective was to understand the heterogeneity in patients’ conceptualisation of RA treatment to inform interventions improving TTT uptake. DESIGN: Eligible participants recruited from an online research registry rated 56 items (on 5-point scales) reflecting concepts raised from patient interviews. Using items describing adhering to physician recommendations to create a binary criterion variable for medication adherence, we conducted a principal components analysis on the remaining items using Varimax rotation, describing how these factors predict adherence over and above demographic characteristics. We further use optimal sets in regression to identify the individual concepts that are most predictive of medication adherence. RESULTS: We found significant heterogeneity in patients’ conceptualisation of RA treatment among 621 persons with RA. A scree plot revealed a four-factor solution explained 38.4% of the variance. The four factors expected to facilitate TTT uptake were (% variance explained): (1) Access to high quality care and support (11.3%); (2) low decisional conflict related to changing disease-modifying antirheumatic drugs (DMARDs) (10.1%); (3) endorsement of a favourable DMARD risk/benefit ratio (9.9%); and (4) confidence that testing reflects disease activity (7.2%). These factors account for 13.8% of the variance in full medication adherence, fully explaining the only significant demographic predictor, age of the patient. The individual items most predictive of poor adherence centre on the lack of effective patient–physician communication, specifically insufficient access to information from rheumatologists, along with the need to seek information elsewhere. CONCLUSION: Patients’ conceptualisation of RA treatment varies; however, almost all patients have difficulty escalating DMARDs, even with access to quality information and an understanding of the benefits of TTT. Tailored interventions are needed to address patient hesitancy to escalate DMARDs.
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spelling pubmed-104818412023-09-07 Understanding Heterogeneity in Patients’ Conceptualisation of Treatment for Rheumatoid Arthritis: A Cluster Analysis Hsiao, Betty Downs, Julie S Lanyon, Mandy Blalock, Susan J Curtis, Jeffrey R Harrold, Leslie R Nowell, William Benjamin Wiedmeyer, Carole Venkatachalam, Shilpa Patterson, Mark T Gavigan, Kelly Stradford, Laura Ali, Danielle Fraenkel, Liana BMJ Open Rheumatology OBJECTIVE: Uptake of treat-to-target (TTT) strategies for rheumatoid arthritis (RA) management is low. Our objective was to understand the heterogeneity in patients’ conceptualisation of RA treatment to inform interventions improving TTT uptake. DESIGN: Eligible participants recruited from an online research registry rated 56 items (on 5-point scales) reflecting concepts raised from patient interviews. Using items describing adhering to physician recommendations to create a binary criterion variable for medication adherence, we conducted a principal components analysis on the remaining items using Varimax rotation, describing how these factors predict adherence over and above demographic characteristics. We further use optimal sets in regression to identify the individual concepts that are most predictive of medication adherence. RESULTS: We found significant heterogeneity in patients’ conceptualisation of RA treatment among 621 persons with RA. A scree plot revealed a four-factor solution explained 38.4% of the variance. The four factors expected to facilitate TTT uptake were (% variance explained): (1) Access to high quality care and support (11.3%); (2) low decisional conflict related to changing disease-modifying antirheumatic drugs (DMARDs) (10.1%); (3) endorsement of a favourable DMARD risk/benefit ratio (9.9%); and (4) confidence that testing reflects disease activity (7.2%). These factors account for 13.8% of the variance in full medication adherence, fully explaining the only significant demographic predictor, age of the patient. The individual items most predictive of poor adherence centre on the lack of effective patient–physician communication, specifically insufficient access to information from rheumatologists, along with the need to seek information elsewhere. CONCLUSION: Patients’ conceptualisation of RA treatment varies; however, almost all patients have difficulty escalating DMARDs, even with access to quality information and an understanding of the benefits of TTT. Tailored interventions are needed to address patient hesitancy to escalate DMARDs. BMJ Publishing Group 2023-09-04 /pmc/articles/PMC10481841/ /pubmed/37666546 http://dx.doi.org/10.1136/bmjopen-2022-070848 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Rheumatology
Hsiao, Betty
Downs, Julie S
Lanyon, Mandy
Blalock, Susan J
Curtis, Jeffrey R
Harrold, Leslie R
Nowell, William Benjamin
Wiedmeyer, Carole
Venkatachalam, Shilpa
Patterson, Mark T
Gavigan, Kelly
Stradford, Laura
Ali, Danielle
Fraenkel, Liana
Understanding Heterogeneity in Patients’ Conceptualisation of Treatment for Rheumatoid Arthritis: A Cluster Analysis
title Understanding Heterogeneity in Patients’ Conceptualisation of Treatment for Rheumatoid Arthritis: A Cluster Analysis
title_full Understanding Heterogeneity in Patients’ Conceptualisation of Treatment for Rheumatoid Arthritis: A Cluster Analysis
title_fullStr Understanding Heterogeneity in Patients’ Conceptualisation of Treatment for Rheumatoid Arthritis: A Cluster Analysis
title_full_unstemmed Understanding Heterogeneity in Patients’ Conceptualisation of Treatment for Rheumatoid Arthritis: A Cluster Analysis
title_short Understanding Heterogeneity in Patients’ Conceptualisation of Treatment for Rheumatoid Arthritis: A Cluster Analysis
title_sort understanding heterogeneity in patients’ conceptualisation of treatment for rheumatoid arthritis: a cluster analysis
topic Rheumatology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10481841/
https://www.ncbi.nlm.nih.gov/pubmed/37666546
http://dx.doi.org/10.1136/bmjopen-2022-070848
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