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      Medication Adherence and Coping Strategies in Patients with Rheumatoid Arthritis: A Cross-Sectional Study

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          Abstract

          Objectives

          The aim of this study was to determine if strategies for coping with illnesses, demographic factors, and clinical factors were associated with medication adherence among patients with rheumatoid arthritis (RA).

          Methods

          This cross-sectional study was conducted at a Viennese rheumatology outpatient clinic on RA patients. Medication adherence was assessed using the Medication Adherence Report Scale. Strategies for coping with illness were assessed using the Freiburg Questionnaire for Coping with Illness.

          Results

          Half (N=63, 52.5%) of the 120 patients included in the study were considered completely medication adherent. Female sex (odds ratio [OR]: 4.57, 95% confidence interval [CI]: 1.14 – 18.42), older age (54-65 yr vs. <45 yr OR: 9.2, CI:2.0-40.70; >65 yr vs. <45 yr OR 6.93, CI:1,17 – 40.87), middle average income (middle average income vs. lowest income class OR= 0.06, CI= 0.01-0.43), and shorter disease duration (5-10 yr vs. >10 yr OR= 3.53, CI= 1.04-11.95; 1-4 yr vs. >10 yr OR=3.71, CI= 1.02-13.52) were associated with higher medication adherence. Levels of active coping (15.57 vs. 13.47, p=0.01) or diversion and self-encouragement (16.10 vs. 14.37, p=0.04) were significantly higher among adherent as opposed to less adherent participants. However, in multivariate regression models, coping strategies were not significantly associated with adherence.

          Conclusions

          Age, sex, monthly net income, and disease duration were found to be associated with an increased risk for medication nonadherence among patients with RA. Coping strategies such as active coping, diversion, and self-encouragement were associated with adherence in univariate models, but not when adjusted for demographic and clinical factors.

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          Most cited references31

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          Appraisal, coping, health status, and psychological symptoms.

          In this study we examined the relation between personality factors (mastery and interpersonal trust), primary appraisal (the stakes a person has in a stressful encounter), secondary appraisal (options for coping), eight forms of problem- and emotion-focused coping, and somatic health status and psychological symptoms in a sample of 150 community-residing adults. Appraisal and coping processes should be characterized by a moderate degree of stability across stressful encounters for them to have an effect on somatic health status and psychological symptoms. These processes were assessed in five different stressful situations that subjects experienced in their day-to-day lives. Certain processes (e.g., secondary appraisal) were highly variable, whereas others (e.g., emotion-focused forms of coping) were moderately stable. We entered mastery and interpersonal trust, and primary appraisal and coping variables (aggregated over five occasions), into regression analyses of somatic health status and psychological symptoms. The variables did not explain a significant amount of the variance in somatic health status, but they did explain a significant amount of the variance in psychological symptoms. The pattern of relations indicated that certain variables were positively associated and others negatively associated with symptoms.
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            Adherence to Long-Term Therapies: Evidence for Action

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              Medication adherence in patients with rheumatoid arthritis: a critical appraisal of the existing literature.

              Adherence to medication in patients with rheumatoid arthritis is low, varying from 30 to 80%. Improving adherence to therapy could therefore dramatically improve the efficacy of drug therapy. Although indicators for suboptimal adherence can be useful to identify nonadherent patients, and could function as targets for adherence-improving interventions, no indicators are yet found to be consistently and strongly related to nonadherence. Despite this, nonadherence behavior could conceptually be categorized into two subtypes: unintentional (due to forgetfulness, regimen complexity or physical problems) and intentional (based on the patient's decision to take no/less medication). In case of intentional nonadherence, patients seem to make a benefit-risk analysis weighing the perceived risks of the treatment against the perceived benefits. This weighing process may be influenced by the patient's beliefs about medication, the patient's self-efficacy and the patient's knowledge of the disease. This implicates that besides tackling practical barriers, clinicians should be sensitive to patient's personal beliefs that may impact medication adherence.
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                Author and article information

                Contributors
                Journal
                Int J Rheumatol
                Int J Rheumatol
                IJR
                International Journal of Rheumatology
                Hindawi
                1687-9260
                1687-9279
                2019
                4 March 2019
                : 2019
                : 4709645
                Affiliations
                12nd Medical Division, Rheumatology, Kaiser Franz Josef Hospital, SMZ-Süd, Kundratstrasse 3, 1100 Vienna, Karl Landsteiner Society of Autoimmunology and Rheumatism, Austria
                2Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria
                Author notes

                Academic Editor: Charles J. Malemud

                Author information
                http://orcid.org/0000-0002-2005-5602
                Article
                10.1155/2019/4709645
                6425297
                30949207
                a37a7f43-b50d-4ed5-a7c8-bca0ec529e00
                Copyright © 2019 Carolin Berner et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 June 2018
                : 17 November 2018
                : 17 February 2019
                Categories
                Research Article

                Rheumatology
                Rheumatology

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