Implication Of Character Traits In Adherence To Treatment In People With Gout: A Reason For Considering Nonadherence As A Syndrome

Gérard Reach; Gaëlle Chenuc; Pascal Maigret; Isabelle Elias-Billon; Luc Martinez; René-Marc Flipo

doi:10.2147/PPA.S227329

Implication Of Character Traits In Adherence To Treatment In People With Gout: A Reason For Considering Nonadherence As A Syndrome

Patient Prefer Adherence. 2019 Nov 7:13:1913-1926. doi: 10.2147/PPA.S227329. eCollection 2019.

Authors

Gérard Reach^{1

2}, Gaëlle Chenuc³, Pascal Maigret⁴, Isabelle Elias-Billon⁴, Luc Martinez⁵, René-Marc Flipo⁶

Affiliations

¹ Department for Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital, APHP, Bobigny, France.
² Health Education and Practices Laboratory (LEPS, EA 3412), Paris 13 University, Sorbonne Paris Cité, Bobigny, France.
³ Capionis Research, Bordeaux, France.
⁴ Medical Department, Menarini, Rungis, France.
⁵ Family Practice, La Rochelle, France.
⁶ Department of Rheumatology, University Hospital, Lille, France.

Abstract

Objective: Various aspects of nonadherence to therapy (including medication and lifestyle nonadherence) often appear together. Here we report the association between treatment adherence in gout and the two character traits of patience and obedience, which may explain this observation.

Methods: Data were collected from a cross-sectional study conducted in a French cohort of 1441 adult patients. Patience was assessed using the choice between receiving €1500 in 1 year or €500 immediately. Obedience was evaluated with a single question assessing the use of the seatbelt in the rear seat of a car. Adherence to recommendations for medication, beverage, food and physical activity and smoking status was assessed using self-report questionnaires.

Results: Patience and obedience were strong determinants of adherence to medication in multivariate analysis (OR 2.056, 95% CI [1.414-2.989], P< 0.001; OR 1.844, 95% CI [1.273-2.671], P=0.001). In univariate analysis, adherence to medication was also associated with compliance with dietary directives (P<0.001), lower alcohol consumption on an ordinary day (P< 0.001), never consuming soda (P<0.001) or beer (P<0.001), practice of physical activity (P=0.002), being a nonsmoker (P<0.001) and monitoring serum levels of uric acid regularly (P=0.011). Multiple-correspondence analysis illustrated the associations of these different aspects of adherence (medication, diet and exercise, smoking status and monitoring of disease control) with patience and obedience. Finally, we observed a link between patience and obedience (P< 0.001).

Conclusion: Character traits, which shape preferences, may cause the clustering of different aspects of nonadherence in the form of a syndrome, elucidating the still enigmatic link between nonadherence to placebo and mortality in randomised clinical trials. This concept may also explain, at least in part, the difficulty of improving adherence to long-term therapies and may lead to ethical issues.

Keywords: adherence; character traits; gout; nonadherence syndrome; obedience; patience.