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. 2021 Jan 5;60(1):125-131.
doi: 10.1093/rheumatology/keaa214.

Translating research into clinical practice: quality improvement to halve non-adherence to methotrexate

Anne Barton  1   2 , Meghna Jani  3 , Christine Bundy  4   5 , James Bluett  1   2 , Stephen McDonald  1 , Brian Keevil  6 , Faraz Dastagir  1 , Melissa Aris  1 , Ian Bruce  1   3 , Pauline Ho  1 , Eoghan McCarthy  1 , Ellen Bruce  1 , Ben Parker  1   3 , Kimme Hyrich  1   3 , Rachel Gorodkin  1
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Translating research into clinical practice: quality improvement to halve non-adherence to methotrexate

Anne Barton et al. Rheumatology (Oxford). .

Abstract

Objective: MTX remains the cornerstone for therapy for RA, yet research shows that non-adherence is significant and correlates with response to therapy. This study aimed to halve self-reported non-adherence to MTX at the Kellgren Centre for Rheumatology.

Methods: An anonymous self-report adherence questionnaire was developed and data collected for 3 months prior to the introduction of interventions, and then regularly for the subsequent 2.5 years. A series of interventions were implemented, including motivational interviewing training, consistent information about MTX and development of a summary bookmark. Information on clinic times was collected for consultations with and without motivational interviewing. Surveys were conducted to ascertain consistency of messages about MTX. A biochemical assay was used to test MTX serum levels in patients at two time points: before and 2.8 years following introduction of the changes. Remission rates at 6 and 12 months post-MTX initiation were retrieved from patient notes and cost savings estimated by comparing actual numbers of new biologic starters compared with expected numbers based on the numbers of consultants employed at the two time points.

Results: Between June and August 2016, self-reported non-adherence to MTX was 24.7%. Following introduction of the interventions, self-reported non-adherence rates reduced to an average of 7.4% between April 2018 and August 2019. Clinic times were not significantly increased when motivational interviewing was employed. Consistency of messages by staff across three key areas (benefits of MTX, alcohol guidance and importance of adherence) improved from 64% in September 2016 to 94% in January 2018. Biochemical non-adherence reduced from 56% (September 2016) to 17% (June 2019), whilst remission rates 6 months post-initiation of MTX improved from 13% in 2014/15 to 37% in 2017/18, resulting is estimated cost savings of £30 000 per year.

Conclusion: Non-adherence to MTX can be improved using simple measures including focussing on the adherence and the benefits of treatment, and providing consistent information across departments.

Keywords: adherence; methotrexate; motivational interviewing; quality improvement.

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Figures

<sc>Fig</sc>. 1
Fig. 1
Bookmark handed to patients highlighting key points regarding MTX
<sc>Fig</sc>. 2
Fig. 2
Self-reported non-adherence to MTX in rheumatology outpatients
See this image and copyright information in PMC

References

    1. Gwinnutt JM, Symmons DPM, MacGregor AJ. et al. Twenty-year outcome and association between early treatment and mortality and disability in an inception cohort of patients with rheumatoid arthritis: results from the Norfolk Arthritis Register. Arthritis Rheumatol 2017;69:1566–75. - PMC - PubMed
    1. Ledingham J, Gullick N, Irving K. et al. BSR and BHPR guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs. Rheumatology (Oxford) 2017;56:865–8. - PubMed
    1. Smolen JS, Landewé R, Bijlsma J. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 2017;76:960–77. - PubMed
    1. Breedveld FC, Weisman MH, Kavanaugh AF. et al. The PREMIER study: a multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum 2006;54:26–37. - PubMed
    1. Bijlsma JWJ, Welsing PMJ, Woodworth TG. et al. Early rheumatoid arthritis treated with tocilizumab, methotrexate, or their combination (U-Act-Early): a multicentre, randomised, double-blind, double-dummy, strategy trial. Lancet 2016;388:343–55. - PubMed

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