Patient Preference and Adherence (Dec 2023)
What Do We Know about Medication Adherence Interventions in Inflammatory Bowel Disease, Multiple Sclerosis and Rheumatoid Arthritis? A Scoping Review of Randomised Controlled Trials
Abstract
Kathryn King,1 Serena McGuinness,1 Natalie Watson,1 Christine Norton,1 Trudie Chalder,2 Wladyslawa Czuber-Dochan1 1Florence Nightingale Faculty Nursing, Midwifery and Palliative Care, King’s College London, London, UK; 2Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UKCorrespondence: Kathryn King, Email [email protected]: Between 53% and 75% of people with inflammatory bowel disease, 30%– 80% with rheumatoid arthritis, and up to 50% with multiple sclerosis do not take medications as prescribed to maintain remission. This scoping review aimed to identify effective adherence interventions for inflammatory bowel disease, but with few studies found, multiple sclerosis and rheumatoid arthritis were included to learn lessons from other conditions.Methods: Full and pilot randomised controlled trials testing medication adherence interventions for inflammatory bowel disease, multiple sclerosis, and rheumatoid arthritis conducted between 2012 and 2021 were identified in six electronic databases.Results: A total of 3024 participants were included from 24 randomised controlled trials: 10 pilot and 14 full studies. Eight investigated inflammatory bowel disease, 12 rheumatoid arthritis, and four multiple sclerosis. Nine studies (37.5%) reported significantly improved medication adherence, all involving tailored, personalised education, advice or counselling by trained health professionals, with five delivered face-to-face and 1:1. Quality of effective interventions was mixed: five rated high quality, two medium and two low quality. Interventions predominantly using technology were likely to be most effective. Secondary tools, such as diaries, calendars and advice sheets, were also efficient in increasing adherence. Only 10 interventions were based on an adherence theory, of which four significantly improved adherence.Conclusion: Tailored, face-to-face, 1:1 interactions with healthcare professionals were successful at providing personalised adherence support. Accessible, user-friendly technology-based tools supported by calendars and reminders effectively enhanced adherence. Key components of effective interventions should be evaluated and integrated further into clinical practice if viable, whilst being tailored to inflammatory conditions.Plain Language Summary: Introduction: Inflammatory bowel disease (IBD), multiple sclerosis (MS), and rheumatoid arthritis (RA) are inflammatory diseases where the immune system causes inflammation by mistakenly attacking itself. These lifelong conditions cannot be cured, but can usually be controlled by medication. Medication is most effective when taken as prescribed, called “adherence”. For multiple reasons, between five and eight in 10 people with IBD, RA, and MS do not take medications as advised. This review aimed to identify research that tested ways to help people living with IBD, MS, and RA take medications as prescribed. Identifying and understanding what helps can increase patient well-being and improve quality of life through better controlled inflammatory conditions.Methods: Studies testing medication adherence interventions for IBD, MS, and RA conducted between 2012 and 2021 were identified from six electronic databases.Results: A total of 3024 people with inflammatory conditions took part in 24 studies (eight on IBD, four on MS, and 12 on RA). Nine studies reported significantly improved medication adherence, all involving personalised education, advice or counselling by trained health professionals, with five delivered face-to-face and individually. Interventions predominantly using technology were the most effective. Diaries, calendars, and advice sheets also increased adherence. Ten of the interventions were based on an adherence theory, of which four improved adherence.Conclusions: Personalised adherence support was successful when:tailored to patient,one-to-one and face-to-face,with healthcare professionals,involving technology-based tools, andsupported by calendars/reminders.Components of effective interventions should be used in clinical practice where possible, made specific to each inflammatory condition.Keywords: IBD, MS, RA, treatment, medicine, drug, concordance
