AB1017 Rheumatoid Arthritis in Greece: Patient Journey, Access To Treatment Barriers and Their Impact To Adherence
Authors: V. Stathakopoulos, A. Evaggelatos, G. Painesis, K. Kottikas
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Early active treatment of rheumatoid arthritis (RA) by a rheumatologist and adherence to the prescribed drugs are crucial factors for inducing remission and preventing irreversible joint damage<sup>1,2</sup>. However, Greece9s fiscal situation has inevitably impacted the healthcare sector by raising barriers to patient access to treatment and medication and limits to patient and doctor education<sup>3</sup>. Hence, identifying obstacles/adherence issues and attempting to overcome them is essential to improving RA care. <h3>Objectives</h3> The objectives of this national patient study were to record: a) the patient journey from the 1st symptom until official diagnosis and the physician specialties that were visited, b) the potential barriers in access to treatment and medicines and c) the possible adherence issues for patients suffering from RA in Greece. <h3>Methods</h3> An innovative research method was followed, using a structured questionnaire. Using a stratified sampling methodology, 1,030,000 randomly selected households were contacted over the telephone, via an Interactive Voice Response (IVR) system asking them to participate in the survey concerning auto-immune diseases. Eventually, 1,422 households agreed to do so and were subsequently interviewed by a telephone researcher. The achieved response rate is well above previous studies and scientifically accepted standrads<sup>4</sup>. <h3>Results</h3> 557 RA patients were identified (90% women, median age 56–65 years), making RA the most prevalent rheumatic autoimmune disease (44% of sample). The average time needed from the 1st symptom until an official diagnosis is 23.3 months. Only 31% of RA patients visited a rheumatologist first and 10% have to make 3 or more visits until they are officially diagnosed. 43% of them did not receive any medicine and of those receiving, 34% were non-adherent during the last six months (at least 1 day late to take the medicine or skipping at least 1 dose). 28% of biological treatment patients were non-adherent. The physician9s visit cost was the main barrier to treatment access (31%), followed by the need to use someone else to pick the medicine due to patients9 inability (18%) and by the difficulty of booking an appointment with a specialist (15%). For SSF pharmacies the distance from the patient9s home (31%) plus a long waiting time (17%) were additional barriers. χ<sup>2</sup> tests revealed that most barriers exerted a statistically significant influence on adherence (p&lt;0.05). <h3>Conclusions</h3> Appropriately educating the public and the doctors about RA9s symptoms and to visit the appropriate physician, and removing the barriers to treatment and medication access will massively benefit RA patients and consequently society. <h3>References</h3> Robinson P, Taylor W. Decreasing time to treatment in rheumatoid arthritis: review of delays in presentation, referral and assessment. Int J Clin Rheumtol 2011; 6: 173–87 Harrold LR, Andrade SE. Medication adherence of patients with selected rheumatic conditions: a systematic review of the literature. Semin Arthritis Rheum 2009; 385: 396–402 Kentikelenis A, Karanikolos M, Reeves A, McKee M, Stuckler D. Greece9s health crisis: from austerity to denialism. Lancet 2014; 383: 748–53 Corkrey R, Parkinson L. Interactive voice response: Review of studies 1989–2000. Behav Res Methods Instrum Comput 2002; 34: 342–53 <h3>Disclosure of Interest</h3> None declared