EducAR: implementing a multicomponent strategy to improve therapeutic adherence in rheumatoid arthritis

Abstract

INTRODUCTION: The EULAR points to consider (PtC) for reducing non-adherence need implementation. OBJECTIVES: To design, implement and evaluate a strategy based on the PtC to improve treatment adherence in rheumatoid arthritis (RA). METHODS: A multidisciplinary panel cocreated an intervention that was subsequently tested in a cluster trial, where centres were randomised to access the developed intervention or follow the standard of care (SOC). 6-month initiation and implementation adherence were measured in consecutive patients with <2 years of RA. The results were discussed among the centres assigned to the intervention to explore barriers and facilitators to implementation. RESULTS: The intervention was a two-sided website. The items on the patient site mainly addressed disease and treatment education, self-management and peer support. The healthcare professional site has tutorials on communication to improve trust and adherence, plus shared decision-making aids. It was tested in 141 RA patients (67 control and 74 intervention). Both groups increased adherence at 6 months, mainly in the control group (48% to 67% vs 42% to 47% in the intervention group). Implementation had been very low in relation to barriers identified as lack of time, inadequate focus (exclusively for nurses) and consideration of the current SOC as adequate. CONCLUSION: Despite designing an intervention based on the best evidence, the results were inconclusive; the lack of a detected effect could be explained by the limited implementation, which was insufficient for the complexity of the changes required (change of culture). TRIAL REGISTER NUMBER: ClinicalTrials.gov ID NCT05425485.