Identifying Patients with Poor Treatment Compliance
Sinead Maguire, Una Martin, Paula Dreelan, Claire Sheehy
Department of Rheumatology, University Hospital Waterford
Poor compliance with treatment is a well-recognized issue in patients with chronic diseases (1). In patients with inflammatory arthritis, this can result in disease progression, irreversible deformity, and increased disability (2). Suboptimal disease control may be compounded or may even be due to poor compliance.
The Health Beacon Reporting System monitors patients’ compliance with medication via the frequency of subcutaneous pen disposals into a sharps container. The system is programmed to record the time and date of the s/c pen disposal and compare to the expected date of disposal. This was an opt-in monitored sharps disposal system on the patient’s part. This allows for accurate assessment of patient compliance with minimal effort and cost on the part of the clinician. Review of this data is a simple way to identify patients with possible compliance issues, which, may otherwise be mistaken for lack of efficacy of the drug.
A retrospective review was carried out on data from all patients on Humira (Adalimumab) being monitored via the AbbVie Care Health Beacon Reporting System since its implementation in March 2016. There were 35 patients identified and information on background demographics, diagnosis, compliance, duration of treatment and current disease status were recorded. Patients were compared on the basis of their disease activity and compliance. Compliance was divided into excellent (81-100% adherence), good (66-80%) and poor (<65%). Disease activity was determined by review of recent clinical notes to be active or stable.
The 35 patients studied had either a diagnosis of rheumatoid arthritis or psoariatic arthritis. The mean duration of treatment was 7.15 months. For most patients (80%), Humira was their first biological agent. This review included patients on combined (57%) and monotherapy (43%) with DMARDs. Of the patients studied 34.3% were classified as having active disease. Of those patients 66.7% had poor compliance with treatment. Interestingly it was also noted that only 43.5% of the patients with stable disease were reported to have good to excellent compliance. Larger patient numbers would provide greater insights into issues affecting compliance.
Compliance should always be considered in patients with active disease. The Health Care Beacon Reporting System can be a helpful tool to the clinician in monitoring compliance. In patients with poor compliance, patient education and identification of issues affecting compliance could significantly affect patient outcomes.