Case Study: Supporting Rheumatoid Arthritis Patient Outcomes With a CBT-Based Support Program
Background
The Challenge
Rheumatoid arthritis is a chronic autoimmune condition that affects the joints and other body systems, including the skin, eyes, lungs, heart, and blood vessels through inflammation.
Although disease modifying anti-rheumatic drugs (DMARDs) can be an effective treatment, they require adherence and persistence of weeks and up to months for its full effect.
Consequently, adherence to such treatments can be as low as 21%, highlighting the need for patient support beyond the immediate healthcare team, especially if the biologic DMARD treatment is taken as an at-home self-injection.
Patients also require support to self-manage the pain associated with living with rheumatoid arthritis, which can be debilitating.
Our Behavior Change Approach
Behavior change techniques and health psychology principles were leveraged to develop a Cognitive Behavioral Therapy (CBT)-based approach to patient support aimed at:
- improving adherence to DMARD therapy
- improving self-management of DMARD treatment and rheumatoid arthritis symptoms
- improving patient quality of life and adjustment to living with an often-debilitating autoimmune condition.
The program was personalized to each patient’s individual needs and risk of nonadherence based on a behavioral screening tool developed to identify their specific barriers to adherence.
- High-risk patients were provided with strategies to maximize adherence and change unhelpful beliefs about the medication and rheumatoid arthritis.
- Low-risk patients were provided with strategies to maintain adherence and prevent relapse.
The Solution
A comprehensive CBT-based patient support program was developed and delivered with registered health psychologists, including:
- a welcome and needs assessment call
- a detailed self-management CBT workbook
- follow up support calls over 6 months from treatment initiation for high-risk patients providing CBT-based interventions
- a satisfaction and DMARD persistence questionnaire once the patient graduates from the program
- healthcare professional feedback loop.
This CBT-based program was designed to support patients starting DMARD therapy to adhere and persist by consciously reflecting on their progress over time.
The Impact
- 90% of patients would recommend the program to someone living with rheumatoid arthritis.
- Both the health psychologist calls and self-management guide were rated 8 out of 10 for helpfulness.
- 85% of patients persisted with DMARD therapy at 6 months.
- 71% of rheumatologists stated the program would impact their choice of treatment for their rheumatoid arthritis patients.
The psychologist helped me change my mindset, she encouraged me to do things and see things from a different perspective.
- Support Program Patient
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