One in Seven: Rheumatology Patient Nonadherence During COVID-19

September is Rheumatic Disease Month, and, while patients always face challenges, the rise of COVID-19 has created an even more difficult environment for them. When living in an immunocompromised state due to many medications that treat rheumatic diseases, patients need to be hypervigilant of the virus, and that focus is one of many factors that have impacted patient adherence in rheumatology.

Recently, researchers dug into over 30 studies to determine what other factors were impacting patient adherence in rheumatology patients during the pandemic. This review showed a rate of non-adherence in nearly 15% of all rheumatology patients during the pandemic, meaning more than one in seven patients failed to stay on their prescription. Out of all patients, 9.5% discussed poor implementation as their reason for non-adherence[1].

With nearly one in ten rheumatology patients facing poor implementation, the rheumatology field has an excellent opportunity to improve patient training and education. VMS Clinical Nurse Educator Tammy May says, “Often, the patient has questions on how the medication works, what to expect, common side effects, and training and education can support these questions.”

Aside from the impact of poor implementation, researchers found that rheumatology patients faced a variety of other systemic and individual barriers during the pandemic. When the pandemic began, fear led some to avoid visits to their doctor or the pharmacy where they may encounter the virus. Researchers also found that patients who stopped their medication during COVID-19 were significantly more likely to report that telehealth options were unavailable to them, that they had difficulties receiving an infusion, or that they had financial concerns around their medication.

Just as there is a need for further training and education in starting patients on their medication, rheumatology patients need further support in maintaining their prescription over time. Telehealth and access support are crucial to maintaining adherence in patients who could slip through the cracks. May says, “We had patients call in with concerns over how they would get their medication. As CNEs, we help patients learn about other options that may be available and lend an ear to the patient’s concerns.” Across the country, nurse educators are an important resource while also providing an emotional outlet for patients.

Another important factor in keeping rheumatology patients healthy is making sure they have received important information about the COVID vaccines. For patients that are already vaccinated, the CDC recently has recommended they receive a third vaccine booster when it is available to them.

“Rheumatology patients being actively treated with high-dose corticosteroids, alkylating agents, antimetabolites, tumor-necrosis factor (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory should receive a third dose of the Pfizer or Moderna vaccines.” – CDC[2]

Whether it is helping the patient start on the medication or stay on the medication, Clinical Educators play an important role in supporting rheumatology patients. “Patients are scared, and understandably so.” May said. “CNEs can provide that ongoing support to help address concerns and provide reassurance.” Without that support, rheumatology patients are at risk of becoming nonadherent, just as one in seven have since

[1] Rebi, N., et al (2021). A rapid review of medication taking (‘adherence’) among patients with rheumatic diseases during the COVID-19 pandemic.  https://doi.org/10.1002/acr.24744

[2] Rheumatology Patients on Immunosuppressive Medications Qualify for Third COVID-19 Vaccine Dose, American College Of Rheumatology Press Release, 8/13/2021