1576 - Ambivalent Attitudes, Accessing Information and Decision-Making: An Interview Study of Medication Use in Early Rheumatoid Arthritis (RA)

Monday, November 7, 2011: 9:00 AM-6:00 PM
Hall F2 - Poster Hall (McCormick Place West)
Anne F. Townsend1, Paul M. Adam2, Catherine L. Backman3, Linda C. Li3 and ERAHSE Team4, 1Arthritis Research Centre of Canada, Vancouver, BC, 2Mary Pack Arthritis Centre, Vancouver, BC, 3University of British Columbia, Vancouver, BC, 4Vancouver & Toronto
Presentation Number: 1576

Background/Purpose: Timely treatment is important to control RA, prevent irreversible joint damage and limit impact on daily life. Prompt intervention with DMARDS is associated with improved outcome but delays exist between disease onset and effective medication use. Evidence shows that multiple factors delay early treatment including diffuse symptom onset, access to health care services, and difficulties in gaining a diagnosis. However, little is known of the patient perspective about early decisions and medication use. The current study investigates patient: 1) attitudes to and experiences of medication use; 2) information-seeking; 3) the decision-making process.

Method: Participants were recruited from rheumatologist and family physician offices, and from newsletters of patient advocacy groups. We conducted in-depth interviews with 38 people (37 women, 1 man), with an RA diagnosis ≤12 months. The interviews were organized around 3 distinct but overlapping areas: 1) Pre-diagnosis symptoms, impact and management; 2) Experiences with health professionals leading up to the diagnosis; 3) Post-diagnosis experiences of symptoms, management and the health care system. Follow-up phone calls were made to check and elaborate on the interview generated data. Analysis was informed by grounded theory and a narrative approach.

Result:Medications were core to people’s disease management. There was a both a reluctance to take medications and a need for them. Participants expressed ambivalence to medication use in a range of ways: 1) They identified an aversion to medications but required them; 2) They accessed information from multiple sources e.g. the Internet, health professionals and social networks, which was wide-ranging and contradictory; 3) There was little perceived opportunity to discuss options and patient knowledge in the rheumatologist consultation 4) There was post diagnosis delay in and resistance to, taking prescribed medications, and a desire to be ‘weaned off’ or reduce medications, but an ongoing search for relief and disease control.

Conclusion: A number of interrelated factors continued to hamper prescribed medication regimens, once diagnosis was confirmed. The obstacles to effective and timely medication treatment illustrated the importance of patient-physician communications. More opportunities for shared decision-making, based on dialogue and exchange of knowledge and information in the rheumatologist consultation may reduce some of the tensions around medication use and facilitate ongoing and effective treatment plans


Keywords: health behaviors, quality of care, rheumatoid arthritis (RA), rheumatologic practice and self-management

Disclosure: A. F. Townsend, None; P. M. Adam, None; C. L. Backman, None; L. C. Li, None.