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L. J. Kay, K. Lapworth, Safety monitoring for disease-modifying anti-rheumatic drugs in primary and secondary care: adherence to local and national guidelines and patients' views, Rheumatology, Volume 43, Issue 1, January 2004, Page 105, https://doi.org/10.1093/rheumatology/keg437
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Musculoskeletal Unit and 1Department of Clinical Effectiveness and Audit, Freeman Hospital, Newcastle upon Tyne, UK
Sir, We were aware that our safety-monitoring requirement for disease-modifying anti-rheumatic drugs (DMARDs) had grown enormously (from 10% of RA patients in 1984 to 80% in 1994), without additional resources, and may no longer have met the patients' needs. We therefore undertook a survey to describe adherence to recommended monitoring intervals for DMARDs in primary and secondary care, to examine patients' views and experiences of DMARD information and monitoring systems and their preferences for change. A questionnaire was sent to the 1838 adult patients prescribed DMARD therapy for a variety of diagnoses from one hospital, addressing these questions.
Response rate was 1251/1838 (68%) after two mailings. Methotrexate and sulphasalazine were by far the most common drugs to be taken (536 and 351, respectively), with smaller numbers taking leflunomide (86) or myocrisin (73), and fewer than 40 each taking hydroxychloroquine, azathioprine, penicillamine and cyclosporin. The majority of patients had a diagnosis of RA, and the sex ratio was 3 female to 1 male. Over 80% of patients could recall being given information about their DMARD therapy and similar numbers could describe appropriate potential adverse reactions; 73% specifically recalled being given an information leaflet about their medication; 88.8% felt the level of information given was ‘about right’, with 1.9% describing the information as ‘too much’ and 9.4% ‘too little’. Those feeling they had received too little information were less likely to recall receiving a leaflet (P < 0.0001), but were no more or less likely to identify appropriate potential adverse effects. The most common sources of information were a hospital doctor, a nurse or the GP, with perhaps surprisingly few recalling being given information by a pharmacist.
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