EducAR: implementing a multicomponent strategy to improve therapeutic adherence in rheumatoid arthritis

Area of Science:

• Rheumatology
• Digital Health Interventions
• Patient Adherence Research

Background:

• The European Alliance of Associations for Rheumatology (EULAR) developed points to consider (PtC) to address non-adherence.
• Implementing these guidelines is crucial for improving patient outcomes in chronic conditions like rheumatoid arthritis (RA).

Purpose of the Study:

• To design, implement, and evaluate a strategy aimed at enhancing treatment adherence in RA patients, grounded in the EULAR PtC.
• Assessing the effectiveness of a novel intervention compared to standard of care (SOC) in improving medication adherence.

Main Methods:

• A multidisciplinary panel co-created a digital intervention based on EULAR PtC.
• A cluster randomized trial compared the intervention group to the SOC group.
• Initiation and implementation adherence were measured over 6 months in RA patients with recent diagnosis (<2 years).

Main Results:

• The intervention comprised a dual-sided website for patients (education, self-management, peer support) and healthcare professionals (communication skills, shared decision-making tools).
• Both groups showed increased adherence, but the control group (SOC) experienced a greater improvement (48% to 67%) compared to the intervention group (42% to 47%).
• Low implementation of the intervention was observed, attributed to barriers such as time limitations, inadequate focus, and the perceived adequacy of the current SOC.

Conclusions:

• The designed intervention, despite being evidence-based, yielded inconclusive results regarding treatment adherence improvement in RA.
• Limited implementation of the intervention was a significant factor, hindering its potential impact.
• The complexity of required changes, including cultural shifts within healthcare settings, may necessitate more robust implementation strategies.