TY - JOUR
T1 - Prevention, screening, assessing and managing of non-adherent behaviour in people with rheumatic and musculoskeletal diseases
T2 - systematic reviews informing the 2020 EULAR points to consider
AU - Ritschl, Valentin
AU - Stamm, Tanja A
AU - Aletaha, Daniel
AU - Bijlsma, Johannes W J
AU - Böhm, Peter
AU - Dragoi, Razvan
AU - Dures, Emma
AU - Estévez-López, Fernando
AU - Gossec, Laure
AU - Iagnocco, Annamaria
AU - Negrón, José B
AU - Nudel, Michal
AU - Marques, Andréa
AU - Moholt, Ellen
AU - Skrubbeltrang, Conni
AU - Van den Bemt, Bart
AU - Viktil, Kirsten
AU - Voshaar, Marieke
AU - Carmona, Loreto
AU - de Thurah, Annette
PY - 2020/11/1
Y1 - 2020/11/1
N2 - 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.
AB - 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.
KW - Epidemiology
KW - Health services research
KW - Patient Care Team
UR - http://www.scopus.com/inward/record.url?scp=85095801100&partnerID=8YFLogxK
U2 - 10.1136/rmdopen-2020-001432
DO - 10.1136/rmdopen-2020-001432
M3 - Review article
SN - 2056-5933
VL - 6
JO - RMD Open
JF - RMD Open
IS - 3
M1 - e001432
ER -