New research shows that economically disadvantaged and ethnically diverse people with rheumatoid arthritis (RA) or systemic lupus erythematosus (lupus) have barriers that keep them from complying with their prescribed medical treatment: fear of side effects, belief that medicines are not working, problems with the health system environment, and medication cost. The research was funded in part by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

Maria G. Garcia Popa-Lisseanu, M.D., and her colleagues conducted their study at Ben Taub General Hospital in Houston, Texas. Focus-group testing was done in patients of Hispanic, African American and non-Hispanic white heritage, all from economically disadvantaged populations. They discussed the reasons why they did not always comply with their medical treatment or keep clinic appointments.

Fear of side effects was the most often-mentioned factor: although most patients were experiencing only mild side effects, they were concerned about long-term damage from continuing on the medications. Some patients felt that the prescribed drugs were not working correctly, either because they were not providing the expected relief from symptoms, or because they were not curing the disease. Problems with the health care system, such as navigating Medicaid requirements and a lack of continuity with the same doctor, also proved to be a barrier. The financial costs of the medications also kept the patients--most of whom had little or no medical coverage--from taking them as prescribed.

Additionally, Hispanic patients cited language barriers as being an obstacle in their medical care. Translators were often difficult to find, and patients were sometimes reluctant to have a stranger present while undergoing a medical examination. Poor communication with the doctor was also a hindrance to satisfactory health care.

Patients also reported a variety of reasons for missing appointments. Sometimes they encountered difficulties with the scheduling system, especially if they had sporadic, unpredictable employment. Financial difficulties also arose for some, who were unable to pay for appointments or could not afford "hidden" costs such as parking fees. Others said that a lack of transportation or the severity of their symptoms on the day of the appointment kept them from attending the clinic.

Previous studies have shown that patients from ethnic minorities and economically disadvantaged populations have worse outcomes from some diseases, including increased disability and death. This study, the authors believe, helps to clarify some of the barriers to effective treatment and may lead to strategies to help these patients adhere more closely to prescribed treatments, resulting in better medical outcomes.

The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a component of the Department of Health and Human Services' National Institutes of Health, is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For additional information, call the NIAMS Clearinghouse toll free at 1-877-22-NIAMS, or visit the NIAMS Web site at

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Garcia Popa-Lisseanu M, et al. Determinants of treatment adherence in ethnically diverse, economically disadvantaged patients with rheumatic disease. J Rheumatol 2005;32(5):913-918.

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