Rheumatology Vol. 43 No. 12 © British Society for Rheumatology 2004; all rights reserved
LETTER TO THE EDITOR |
Re: Goodacre and Goodacre. Factors influencing the beliefs of patients with rheumatoid arthritis regarding disease-modifying medication
Nuffield Orthopaedic Centre, Oxford, UK 1 Nicosia Polyclinic, Nicosia, Cyprus and 2 Great Western Hospital, Swindon, UK
Correspondence to: W. Holden, Department of Rheumatology, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK.
SIR, Goodacre and Goodacre [1] highlighted the complex belief systems of patients relating to disease-modifying anti-rheumatic drugs (DMARDs), with patients expressing strong concerns relating to potential long-term effects. Their patient group was selected and highly motivated, having undertaken in-depth interviews, completed activity diaries and attended focus groups. We surveyed an unselected group of rheumatology out-patients in three hospitals (Oxford, Swindon and Cirencester) and found an unexpectedly high level of basic misunderstanding about DMARDs. We invited routine follow-up general rheumatology out-patients to complete a simple, anonymous questionnaire before their clinic appointment. We asked them to name their disease, to list their prescribed rheumatological medications, the purpose of these medications, whether they required blood tests and the reasons for the blood tests. Two hundred and ten patients completed the questionnaire. One hundred and ninety-eight (94%) were able to name their rheumatological disease. Twelve (6%) were unable to name their disease or had no idea why they were attending a rheumatology clinic, even though all were follow-up patients. Of 112 (53%) taking DMARDs only 24 (21%) correctly stated the purpose and 12 (11%) thought their DMARD was a pain killer. One hundred and six (95%) on DMARDs were aware of the need for regular blood test monitoring. Of those on DMARDs, 49 (46%) had no idea why they required blood tests, 50 (47%) had a partially correct knowledge of the reason and only 8 (7.5%) gave complete explanations for the blood tests. Six patients (5%) taking DMARDs believed that they did not need to have regular blood tests. It is often assumed that patients understand and retain information and education provided about their DMARDs. Our study brings to light a serious and unexpected level of misunderstanding about DMARDs by our rheumatology out-patients. Goodacre and Goodacre's patients were a selected and motivated group. The level of ignorance amongst the general rheumatology population is likely to be higher than in their sample. Poor understanding of important information may have an impact on patient expectations and compliance, and potentially have serious consequences in terms of adverse drug effects and disability outcomes. Both studies underline the need for constant reinforcement of educational messages.
The authors have declared no conflicts of interest.
References
- Goodacre LJ, Goodacre JA. Factors influencing the beliefs of patients with rheumatoid arthritis regarding disease-modifying medication. Rheumatology 2004;43:583–6.
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