EULAR Guidance on Patient Adherence to Meds Save

Non-adherence may be the single most untold risk to suboptimal outcomes in the care of musculoskeletal disease.  It has been estimated that 30-80% of patients with rheumatic and musculoskeletal diseases (RMDs) are nonadherent to prescribed regimens.  EULAR has commissioned a task force to study the issue, review the literature and provide perspective and guidance. 

The task force developed 4 overarching principles and nine points of consideration (PtCs) for healthcare providers (HCPs). These PtCs can help build better adherence but improving communication, building trust, overcoming structural barriers, assessing in a blame-free environment and tailoring the solution to the problem.

Overarching Principles

• Adherence impacts the outcomes of people with RMDs
• Shared decision making is key, since adherence is a behaviour following an agreed prescription
• Adherence is influenced by multiple factors (comorbidities, treatments, cognitions and preferences) 
• Adherence is a dynamic process that requires continuous evaluation

Points to Consider

1. All HCPs involved in the management of people with RMDs should take responsibility for promoting adherence
2. Effective patient-health professional communication should be applied to enhance adherence
3. Barriers and facilitators of adherence of a specific patient to a specific prescription should be appropriately evaluated
4. Patient education should be provided for people with RMDs as an integral part of standard care
5. Care should be tailored to patient preferences and goals to enhance adherence
6. Adherence should be discussed regularly based on open questions and particularly when disease is not well controlled
7. HCP should explore which factors might negatively influence adherence, including opportunity (eg, availability or cost), capability (eg, memory problems) or motivation (eg, concerns)
8. Together with the patient, the HCP should tailor the approach to overcome individual barriers to adherence, for example, simplifying the regimen, using reminders, providing education, discussing the patient’s beliefs on treatments
9. When specific expertise or interventions for adherence are needed, they should be made available to patients