Treatment Compliance Barriers in Economically
Challenged, Ethnically Diverse Arthritis and Lupus Patients
New research shows that economically disadvantaged and
ethnically diverse people with rheumatoid arthritis
(RA) or systemic lupus
erythematosus
(lupus)
have barriers that keep them from complying with their prescribed medical
treatment: fear of side effects, belief
that medicines are not working, problems with the health system environment, and
medication cost. The research was funded in part by a grant from the National
Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
Maria G. Garcia Popa-Lisseanu, M.D., and her colleagues
conducted their study at Ben Taub General Hospital in Houston, Texas. Focus-group testing was done in
patients of Hispanic, African American and non-Hispanic white heritage, all from
economically disadvantaged populations. They discussed the reasons why they did
not always comply with their medical treatment or keep clinic appointments.
Fear of side effects was the most often-mentioned
factor: although most patients were experiencing only mild side effects, they
were concerned about long-term damage from continuing on the medications. Some
patients felt that the prescribed drugs were not working correctly, either
because they were not providing the expected relief from symptoms, or because
they were not curing the disease. Problems with the health care system, such as navigating Medicaid
requirements and a lack of continuity with the same doctor, also proved to be a
barrier. The financial costs of the medications also kept the patients--most of
whom had little or no medical coverage--from taking them as prescribed.
Additionally, Hispanic patients cited language barriers as being an obstacle
in their medical care. Translators were often difficult to find, and patients
were sometimes reluctant to have a stranger present while undergoing a medical
examination. Poor communication with the doctor was also a hindrance to
satisfactory health care.
Patients also reported a variety of reasons for missing
appointments. Sometimes they encountered difficulties with the scheduling
system, especially if they had sporadic, unpredictable employment. Financial difficulties also
arose for some, who were unable to pay for appointments or could not afford
"hidden" costs such as parking fees. Others said that a lack of transportation
or the severity of their symptoms on the day of the appointment kept them from
attending the clinic.
Previous studies have shown that patients from ethnic minorities and
economically disadvantaged populations have worse outcomes from some diseases,
including increased disability and death. This study, the authors believe, helps
to clarify some of the barriers to effective treatment and may lead to
strategies to help these patients adhere more closely to prescribed treatments,
resulting in better medical outcomes.
The mission of the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS), a component of the Department of
Health and Human Services' National Institutes of Health, is to support research
into the causes, treatment, and prevention of arthritis
and musculoskeletal and
skin diseases; the training of basic and clinical scientists to carry out this
research; and the dissemination of information on research progress in these
diseases. For additional information, call the NIAMS Clearinghouse toll free at
1-877-22-NIAMS, or visit the NIAMS Web site at www.niams.nih.gov.
# # #
Garcia Popa-Lisseanu M, et al. Determinants of treatment adherence in
ethnically diverse, economically disadvantaged patients with rheumatic disease.
J Rheumatol 2005;32(5):913-918.
SOURCE: National Institute of Arthritis and Musculoskeletal and Skin Diseases, www.niams.nih.gov
Last Editorial Review: 8/3/2006
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