Influence of patient characteristics on perceived risks and willingness to take a proposed anti-rheumatic drug

Richard W Martin,James D Birmingham,Kelsey Mccallops,Donald J Tellinghuisen,Andrew J Head,Aaron T Eggebeen

doi:10.1186/1472-6947-13-89

Abstract

BackgroundThe causes of the underutilization of disease modifying anti-rheumatic drugs (DMARDS) for rheumatoid arthritis (RA) are not fully known, but may in part, relate to individual patient factors including risk perception. Our objective was to identify the determinants of risk perception (RP) in RA patients and predictors of their willingness to take a proposed DMARD (DMARD willingness).MethodsA cross-sectional mail survey of RA patients in a community rheumatology practice. Patients were presented a hypothetical decision scenario where they were asked to consider switching DMARDs. They evaluated how risky the proposed medication was and how likely they would be to take it.ResultsThe completed sample included 1009 RA patients. The overall survey response rate was 71%. Patient characteristics: age 61.6 years (range 18-93), 75% female, minority 6.5%, low or marginal health literacy 8.8%, depression 15.0%, duration RA 13.1 years (range 0.5 – 68). Regression models demonstrated that health literacy, independent of low educational achievement or other demographic (including race), was a common predictor of both RP and DMARD willingness. There was partial mediation of the effects of HL on DMARD willingness through RP. Depression and happiness had no significant effect on RP or DMARD willingness. RP was influenced by negative RA disease and treatment experience, while DMARD willingness was affected mainly by perceived disease control.ConclusionsRisk aversion may be the result of potentially recognizable and correctable cognitive defect. Heightened clinician awareness, formal screening for low health literacy or cognitive impairment in high-risk populations, may identify patients could benefit from additional decision support.

Highlights

The causes of the underutilization of disease modifying anti-rheumatic drugs (DMARDS) for rheumatoid arthritis (RA) are not fully known, but may in part, relate to individual patient factors including risk perception
The sample frame was created from the practice electronic health record registry and included patients having received care between March 1, 2010 and February 28, 2011 and who were billed under the ICD-9 code 714.0 (RA). 1436 patients were identified in total
First we evaluated the relationship between Health literacy (HL) and DMARD willingness

Summary

Introduction

The causes of the underutilization of disease modifying anti-rheumatic drugs (DMARDS) for rheumatoid arthritis (RA) are not fully known, but may in part, relate to individual patient factors including risk perception. When patients consider medication information they process the risks affectively as well as cognitively [7]. A good decision is informed, consistent with patient values and acted on [9]. This depends on an individual’s ability to understand and evaluate options and to make judgments that are relatively free of bias [10]. The specific effects of depression, happiness, and cognition on risk perception have been only incompletely studied in medical decisions. In this study we evaluate how patient demographics, RA disease and treatment related experience, mood and health literacy influence risk perception and DMARD willingness

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