Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Feb 27;11(1):e004989.
doi: 10.1136/rmdopen-2024-004989.

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

María Ahijón Lana  1 , Francisca Sivera Mascaró  2   3 , Antonio Fernández-Nebro  4 , Sara Muntadas Castelló  5 , Marina Pérez  6 , Teresa Otón  7 , María Jesús García de Yébenes  7 , Loreto Carmona  7 ; EDUCAR Group
Collaborators, Affiliations
Randomized Controlled Trial

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

María Ahijón Lana et al. RMD Open. .

Abstract

Introduction: The EULAR points to consider (PtC) for reducing non-adherence need implementation.

Objectives: To design, implement and evaluate a strategy based on the PtC to improve treatment adherence in rheumatoid arthritis (RA).

Methods: A multidisciplinary panel cocreated an intervention that was subsequently tested in a cluster trial, where centres were randomised to access the developed intervention or follow the standard of care (SOC). 6-month initiation and implementation adherence were measured in consecutive patients with <2 years of RA. The results were discussed among the centres assigned to the intervention to explore barriers and facilitators to implementation.

Results: The intervention was a two-sided website. The items on the patient site mainly addressed disease and treatment education, self-management and peer support. The healthcare professional site has tutorials on communication to improve trust and adherence, plus shared decision-making aids. It was tested in 141 RA patients (67 control and 74 intervention). Both groups increased adherence at 6 months, mainly in the control group (48% to 67% vs 42% to 47% in the intervention group). Implementation had been very low in relation to barriers identified as lack of time, inadequate focus (exclusively for nurses) and consideration of the current SOC as adequate.

Conclusion: Despite designing an intervention based on the best evidence, the results were inconclusive; the lack of a detected effect could be explained by the limited implementation, which was insufficient for the complexity of the changes required (change of culture).

Trial register number: ClinicalTrials.gov ID NCT05425485.

Keywords: Outcome and Process Assessment, Health Care; Patient Care Team; Qualitative research.

PubMed Disclaimer

Conflict of interest statement

Competing interests: The principal investigator (MAL) received grants to support different project stages from MSD, Roche, and the Spanish Society of Rheumatology. The funds did not go directly to the PI. These were used by her institution (Hospital de la Princesa Foundation) for design services (MP) and research consultancy at the Instituto de Salud Musculoesquelética (Inmusc). LC, TO and MJGY are employees of Inmusc and do not prescribe. Inmusc works by contract for laboratories among other institutions, such as Galapagos, Pfizer, Lilly, MSD, Novartis, Roche, Sanofi Aventis, BMS and Sandoz. The rest of the authors declare no conflicts of interest with the manuscript's content. The EducAR programme is offered openly at no cost.

Figures

Figure 1
Figure 1. EducAR’s general and patients’ landing pages with distributing pages.
Figure 2
Figure 2. EducAR’s health professionals’ landing pages with distributing pages.
See this image and copyright information in PMC

References

    1. Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388:2023–38. doi: 10.1016/S0140-6736(16)30173-8. - DOI - PubMed
    1. van den Bemt BJF, van den Hoogen FHJ, Benraad B, et al. Adherence rates and associations with nonadherence in patients with rheumatoid arthritis using disease modifying antirheumatic drugs. J Rheumatol. 2009;36:2164–70. doi: 10.3899/jrheum.081204. - DOI - PubMed
    1. van den Bemt BJF, Zwikker HE, van den Ende CHM. Medication adherence in patients with rheumatoid arthritis: a critical appraisal of the existing literature. Expert Rev Clin Immunol. 2012;8:337–51. doi: 10.1586/eci.12.23. - DOI - PubMed
    1. Pasma A, Schenk C, Timman R, et al. Does non-adherence to DMARDs influence hospital-related healthcare costs for early arthritis in the first year of treatment? PLoS One. 2017;12:e0171070. doi: 10.1371/journal.pone.0171070. - DOI - PMC - PubMed
    1. World Health Organization Adherence to long-term therapies: evidence for action. 2003. https://www.who.int/chp/knowledge/publications/adherence_report/en Available.

Publication types

Substances

Associated data