SAT0608-HPR EULAR POINTS TO CONSIDER FOR THE DETECTION, ASSESSMENT AND MANAGEMENT OF NON-ADHERENCE IN PEOPLE WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES
Authors: V. Ritschl, T. Stamm, D. Aletaha, J. W. Bijlsma, P. Boehm, R. Dragoi, E. Dures, F. Estévez-López, L. Gossec, A. Iagnocco, M. Nudel, A. Marques, E. Moholt, B. Van den Bemt, K. Viktil, M. Voshaar, A. De Thurah, L. Carmona
Journal: Annals of the Rheumatic Diseases (2020)

Background: Non-adherence to medication and non-pharmacological interventions precludes reaching an optimal outcome. 30 to 80% of patients with rheumatic and musculoskeletal diseases (RMDs) do not adhere to their recommended treatment regimens. Objectives: The objective of this EULAR task force was to establish recommendations/points to consider (PtC) for the detection, assessment and management of non-adherence in people with RMDs. Methods: A EULAR task force (TF) was established, and the EULAR standardised operating procedures for the development of PtCs were followed. The TF included rheumatologists, health professionals in rheumatology (HPRs), and patient-representatives from 12 countries. A systematic literature review of reviews was conducted in advance to support the TF in formulating the PtC. Agreement was obtained by Delphi technique in three rounds (0-10 rating scale). Results: A definition of adherence, 4 overarching principles and 9 PtC were formulated (table). Conclusion: The PtCs can help health-care providers to support people with RMDs to adhere to the agreed treatment plan. Table. Overarching principles and points to consider. Definition of Adherence Adherence is defined as the extent to which a person’s behaviour corresponds with the agreed prescription. Overarching principles Agreement 1 Adherence impacts the outcomes of people with RMDs. 99 2 Shared decision making is key, since adherence is a behaviour following an agreed prescription. 96 3 Adherence is influenced by multiple factors. 98 4 Adherence is a dynamic process that requires continuous evaluation. 96 Points to consider Agreement 1 All HCPs involved in the management of people with RMDs should take responsibility for promoting adherence. 99 2 Effective patient-health professional communication should be applied to enhance adherence. 99 3 Barriers and facilitators of adherence of a specific patient to a specific prescription should be appropriately evaluated. 95 4 Patient education should be provided for people with RMDs as an integral part of standard care. 96 5 Care should be tailored to patient preferences and goals to enhance adherence. 98 6 Adherence should be discussed regularly based on open questions and particularly when disease is not well controlled. 99 7 The HCP should explore which factors might negatively influence adherence, including: opportunity (e.g., availability or cost), capability, (e.g., memory problems), motivation (e.g., concerns). 94 8 Together with the patient, the HCP should tailor the approach to overcome individual barriers to adherence, e.g., 98 - 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. 98 HCP, health-care providers; RMDs, rheumatic and musculoskeletal diseases Disclosure of Interests: Valentin Ritschl: None declared, Tanja Stamm Grant/research support from: AbbVie, Roche, Consultant of: AbbVie, Sanofi Genzyme, Speakers bureau: AbbVie, Roche, Sanofi, Daniel Aletaha Grant/research support from: AbbVie, Novartis, Roche, Consultant of: AbbVie, Amgen, Celgene, Lilly, Medac, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi Genzyme, Speakers bureau: AbbVie, Celgene, Lilly, Merck, Novartis, Pfizer, Sanofi Genzyme, UCB, Johannes WJ Bijlsma Grant/research support from: Roche, Speakers bureau: Roche, Lilly, Peter Boehm: None declared, Razvan Dragoi Speakers bureau: MSD, AbbVie, Novartis, Roche, Pfizer, Myllan, Sandoz, Emma Dures Grant/research support from: Independent Learning Grant from Pfizer, combined funding for a research fellow from Celgene, Abbvie and Novartis, Paid instructor for: A fee from Novartis to deliver training to nurses., Fernando Estévez-López: None declared, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, Annamaria Iagnocco Grant/research support from: Abbvie, MSD and Alfasigma, Consultant of: AbbVie, Abiogen, Alfasigma, Biogen, BMS, Celgene, Eli-Lilly, Janssen, MSD, Novartis, Sanofi and Sanofi Genzyme, Speakers bureau: AbbVie, Alfasigma, BMS, Eli-Lilly, Janssen, MSD, Novartis, Sanofi, Michal Nudel: None declared, Andrea Marques: None declared, Ellen Moholt: None declared, Bart van den Bemt Grant/research support from: UCB, Pfizer and Abbvie, Consultant of: Delivered consultancy work for UCB, Novartis and Pfizer, Speakers bureau: Pfizer, AbbVie, UCB, Biogen and Sandoz., Kirsten Viktil: None declared, Marieke Voshaar Grant/research support from: part of phd research, Speakers bureau: conducting a workshop (Pfizer), Annette de Thurah Grant/research support from: Novartis (not relevant for the present study)., Speakers bureau: Lily (not relevant for the present study)., Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp &amp; Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution)