This study addresses the effect of a nurse managed intervention on adherence to Non-Steroidal Inflammatory Drugs among poorly adhering, older, outpatients with Rheumatoid Arthritis (RA). Adherence to prescribed medication regimen is a major issue in the treatment of chronic disease. Yet few randomized, controlled studies have been carried out to guide intervention, with the majority of these carried out among patients with asymptomatic, chronic disease. Little is known about ways to remediate or maintain adherence in patients with symptomatic chronic disease. This study uses RA as a model to study adherence in symptomatic chronic disease. RA affects nearly 6.5 million Americans and is associated with significant disability and human suffering. This study proposes a randomized controlled trial of a cognitive-behavioral nursing intervention designed to improve and then maintain medication adherence among poorly adhering patients with RA. Two hundred and ten outpatients age 50 and over with RA of at least two years duration, according to 1987 ARA diagnostic criteria, adhering less than 80% will be randomized into one of three groups: Adherence Intervention Only (AIO), Adherence Intervention plus Maintenance (AIM) or Usual Care (UC). The intervention strategies are based on previous research with the asymptomatic chronic medical conditions, and are designed to be easily incorporated into outpatient nursing care. Intervention is directed toward the patient's model of RA and its treatment, strategies for coping with specific impediments to adherence, and motivation. Adherence will be monitored by means of self-report and through use of an electronic monitor housed in a medication container cap--a recent and significant technological advance in adherence assessment. Supplementary correlative studies include an assessment of the relationship of selected cognitive, environmental, economic, and side effect factors with adherence, as well as the effect of adherence on functional status and pain, both prospectively and concurrently. The findings of the study will contribute to our understanding of non-adherence and its remedy specifically in rheumatoid arthritis and more generally to other chronic symptomatic diseases. If the intervention is successful, the study will contribute outpatient nursing interventions for use with poorly adhering patients with symptomatic chronic disease in both the clinical and the clinical research settings.
| Dunbar-Jacob, Jacqueline; Holmes, Janice L; Sereika, Susan et al. (2004) Factors associated with attrition of African Americans during the recruitment phase of a clinical trial examining adherence among individuals with rheumatoid arthritis. Arthritis Rheum 51:422-8 |
| Dunbar-Jacob, Jacqueline; Bohachick, Patricia; Mortimer, Mary Kay et al. (2003) Medication adherence in persons with cardiovascular disease. J Cardiovasc Nurs 18:209-18 |
