Rheumatoid arthritis is autoimmune disease that affects the entire body. People with RA are almost twice as likely as the average person to die from a heart attack and are nine times more likely to develop a serious lung disease. Treating RA aggressively is important, but patients are often reluctant to do so if they feel their symptoms are under control.
Researchers at the UNC Eshelman School of Pharmacy at the University of North Carolina at Chapel Hill want to see if providing RA patients with clearer information about their medications and teaching them how to evaluate that information will improve patients’ ability to manage their disease with medication. The team, led by Susan Blalock, M.P.H, Ph.D., have been approved for a $2 million funding award to improve medication self-management among patients with rheumatoid arthritis. Blalock is a professor in the Division of Pharmaceutical Outcomes and Policy in the pharmacy school and the principal investigator on the three-year award from the Patient-Centered Outcomes Research Institute.
It is important to treat RA aggressively with disease-modifying antirheumatic drugs to control inflammation that can damage joints and internal organs, but patients are often reluctant to do so because of concerns about side-effects, Blalock said.
“Patients often think that if their symptoms are under control then their disease is under control,” Blalock said. “But RA doesn’t only affect the joints in one’s body; it affects one’s entire body.”
The risk of death from a heart attack for patients with RA is almost twice that of the general population. RA patients are nine times more at risk of interstitial lung disease and are three times more likely to die from it compared to those without RA.
There is a clear gap between the information patients want about medication risks and benefits, and the information they currently receive as part of routine care, Blalock said. Patients often find it difficult to obtain accurate and personally relevant information about medication risks and benefits that is written in language they can understand.
In a study of 300 subjects, Blalock’s research team will attempt to address the problem by testing combinations of two techniques.
Some patients will receive simplified written materials concerning medication risks and benefits using the DrugFactsBox format, developed by Steven Woloshin, M.D. and Lisa Schwartz, M.D., at Dartmouth University. To help patients develop the skills needed to process medication-related information, patients will go through Strategic Memory Advanced Reasoning Training, a six-hour gist-reasoning training program developed by Sandra Chapman, Ph.D., and colleagues at the Center for Brain Health at the University of Texas at Dallas.
Other members of the research team include: Delesha Carpenter, Ph.D., M.S.P.H., in the School’s Division of Pharmaceutical Outcomes and Policy; Elizabeth Solow, M.D, and David Karp, M.D., at the University of Texas Southwestern Medical Center; Valerie Reyna, Ph.D., at Cornell University; and Carol Edmonds of Hillsborough, North Carolina; and Cynthia Johnson and Kimberlee O’Neill of Chapel Hill. Edmonds, Johnson and O’Neill who will represent patient stakeholders.
The award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.
PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better informed health-care decisions. For more information about PCORI’s funding, visit www.pcori.org.