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A qualitative interview study: patient accounts of medication use in early rheumatoid arthritis from symptom onset to early postdiagnosis.

ABSTRACT: To examine accounts of medication use in participants with early rheumatoid arthritis (RA) from symptom onset to early postdiagnosis.Qualitative study with in-depth, personal interviews.37 women and one man, aged 30-70s, with a diagnosis of RA <12 months.Participants' experiences and feelings of medication use in early RA.British Columbia, Canada.Medications were central to how people managed symptoms and disease. Two main themes were identified, showing that optimum medication use was hampered, and how this related to delayed diagnosis and effective care. The first theme, 'paradox of prediagnosis reliance on over the counter (OTC) medications', describes how people's self-management with OTC medications was 'effective'. Participants relied extensively on OTC medications for pain relief and to maintain 'normal life'. However, as this contributed to delayed medical consultation, diagnosis and effective treatment, OTC medication was also potentially detrimental to disease outcome. The second theme, 'ambivalence around prescription medications post diagnosis', describes how adherence was hindered by patient beliefs, priorities and ambivalence towards medications.This study highlights how people use medications in early RA and contributes to a better understanding of medication use that may transfer to other conditions. Given the drive towards active self-management in healthcare and patients' ambivalence about using strong medications, an in-depth understanding of how these combined factors impact patient experiences will help healthcare providers to support effective medication practices. The reported extensive reliance on OTC medications may speak to a care gap needing further investigation in the context of health behaviours and outcomes of patient self-management.

SUBMITTER: Townsend A

PROVIDER: S-EPMC3586058 | biostudies-other | 2013

REPOSITORIES: biostudies-other

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A qualitative interview study: patient accounts of medication use in early rheumatoid arthritis from symptom onset to early postdiagnosis.

Townsend Anne A Backman Catherine L CL Adam Paul P Li Linda C LC

BMJ open 20130213 2

<h4>Objective</h4>To examine accounts of medication use in participants with early rheumatoid arthritis (RA) from symptom onset to early postdiagnosis.<h4>Design</h4>Qualitative study with in-depth, personal interviews.<h4>Participants</h4>37 women and one man, aged 30-70s, with a diagnosis of RA <12 months.<h4>Main outcome measure</h4>Participants' experiences and feelings of medication use in early RA.<h4>Setting</h4>British Columbia, Canada.<h4>Results</h4>Medications were central to how peop ...[more]

PMID: 23408077

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Project description:BackgroundRheumatoid arthritis (RA) is characterized by recurrent fluctuations in symptoms such as joint pain, swelling, and stiffness. Remote measurement technologies (RMTs) offer the opportunity to track symptoms continuously and in real time; therefore, they may provide a more accurate picture of RA disease activity as a complement to prescheduled general practitioner appointments. Previous research has shown patient interest in remote symptom tracking in RA and has provided evidence for its clinical validity. However, there is a lack of co-design in the current development of systems, and the features of RMTs that best promote optimal engagement remain unclear.ObjectiveThis study represents the first in a series of work that aims to develop a multiparametric RMT system for symptom tracking in RA. The objective of this study is to determine the important outcomes for disease management in patients with RA and how these can be best captured via remote measurement.MethodsA total of 9 patients (aged 23-77 years; mean 55.78, SD 17.54) with RA were recruited from King's College Hospital to participate in two semistructured focus groups. Both focus group discussions were conducted by a facilitator and a lived-experience researcher. The sessions were recorded, transcribed, independently coded, and analyzed for themes.ResultsThematic analysis identified a total of four overarching themes: important symptoms and outcomes in RA, management of RA symptoms, views on the current health care system, and views on the use of RMTs in RA. Mobility and pain were key symptoms to consider for symptom tracking as well as symptom triggers. There is a general consensus that the ability to track fluctuations and transmit such data to clinicians would aid in individual symptom management and the effectiveness of clinical care. Suggestions for visually capturing symptom fluctuations in an app were proposed.ConclusionsThe findings support previous work on the acceptability of RMT with RA disease management and address key outcomes for integration into a remote monitoring system for RA self-management and clinical care. Clear recommendations for RMT design are proposed. Future work will aim to take these recommendations into a user testing phase.

Project description:BackgroundWithdrawal of disease-modifying anti-rheumatic drugs (DMARDs) once disease remission is achieved is endorsed by current international rheumatoid arthritis (RA) management guidelines. However, very little data exists concerning patients' views of this practice. In this qualitative study, we aimed to explore patients' perspectives on DMARD withdrawal in the setting of established RA.MethodsIn this qualitative interview study, patients with stable established RA were recruited from rheumatology outpatient clinics at a large UK teaching hospital. The perceived advantages and disadvantages of DMARDs and views on DMARD withdrawal were explored in semi-structured interviews. Interview transcripts were analysed using standard qualitative techniques to construct an analytical framework.ResultsThirteen participants (8 female, median [IQR] age 65 [61-73]) expressed their views of DMARD treatment in the context of their "normal lives". For some patients, disadvantages such as medication side-effects and the inconvenience of safety monitoring were sufficient hindrances to their lifestyle to justify DMARD withdrawal. However, patients who were vulnerable to loss of physical function, or who had prior experience of severe rheumatoid arthritis, expressed a strong preference against DMARD withdrawal, viewing the potential for increased pain and future disability as unacceptable risks.ConclusionsPatients view DMARD withdrawal in the context of either restoring or threatening their "normal lives". In this model, social and personal factors play a crucial role in influencing patients' opinions of DMARD therapy beyond a simple consideration of medication side-effects alone. A formulaic approach to DMARD withdrawal determined and imposed by clinicians would not be successful. Instead, the discussion of DMARD withdrawal should take place with the identification of patients' priorities and in the context of their personal disease experiences.Trial registrationclinicaltrials.gov (NCT02064400), retrospectively registered 17 February 2014.

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A qualitative interview study: patient accounts of medication use in early rheumatoid arthritis from symptom onset to early postdiagnosis.

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A qualitative interview study: patient accounts of medication use in early rheumatoid arthritis from symptom onset to early postdiagnosis.

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