Utilizing a Patient Navigator to Improve Oral DMARD Medication Adherence among Rheumatoid Arthritis Patients
Brigham and Women's Hospital
Approved: August 2013
Grant Period: October 2013– September 2015
Non‐adherence to disease modifying antirheumatic drugs (DMARDs) is common and associated with several modifiable patient and system factors, including lack of patient education, side effects, disease activity, perceptions about medication effectiveness, attitudes towards medication use, self‐efficacy regarding medication adherence and health system barriers. The overall goal of this intervention is to utilize a patient navigator, a layperson trained to guide patients through the health care system based on their individual needs, to reduce oral DMARD non‐adherence among rheumatoid arthritis (RA) patients. The navigator model has been used to improve cancer screening and chronic disease management and to reduce health disparities. The “DMARD Adherence Navigator” that we proposed will address both patient‐centered and system‐level factors that contribute to oral DMARD non‐adherence.
To achieve the overall goal, we propose two key objectives:
- To implement a patient navigator intervention specifically to reduce oral DMARD non‐adherence, and
- To test the feasibility and effectiveness of the DMARD Adherence Navigator in a controlled trial.
In current work, we have developed a navigator model to improve patients’ access to rheumatology care and will now re‐focus the navigator’s role to improve oral DMARD adherence. We will train the navigator and provide supporting educational materials through a collaborative process with key stakeholders. The intervention will be tested in a busy rheumatology practice at Brigham and Women’s Hospital (BWH). The intervention will compare results of the primary outcome – oral DMARD adherence – at BWH with several satellite practices that are comparable to BWH.