RhEumatoid Arthritis MEDIcation Adherence

The primary endpoint is the rate of adherent patients to DMARDs after 12 months of follow-up assessed by the Medication Possession Ratio (MPR).

The MPR is calculated for each drug: total quantity of dose units dispensed compared to the theoretical quantity of dose units necessary for compliance with the prescribed dosage. The calculation will be made from:

• dispensing data collected from the patient's community pharmacist (control and intervention group),
• prescription data from all prescriptions (between Month 0 and Month 12), reported by the patient during the visit to Month 12,
• and hospitalization data from the medicalized information system program (PMSI:) and the patient log.

A patient is considered adherent to his treatment if the MPR is greater than or equal to 80%. For patients with more than one DMARD drug prescribed, they will be considered adherent if the MPR of each DMARD is greater than or equal to 80%.

A Disease Activity Score (DAS) indicates the severity of rheumatoid arthritis disease activity at a given moment in time. It is calculated based on several different factors, including lab results, patient feedback, and joint swelling and tenderness.

A traditional DAS score requires examining 44 specific joints.

The DAS28 score is arrived at using:

The number of swollen joints (out of the 28), The number of tender joints (out of the 28), The C reactive protein (CRP) or erythrocyte sedimentation rate (ESR) lab test results Answers to a patient health assessment questionnaire A mathematical formula is used to calculate the overall score. DAS28 can range from 0 to 9.4.

Generally, a DAS28 score of:

More than 5.1 indicates high disease activity Between 3.2 and 5.1 indicates moderate disease activity Between 2.6 and less than 3.2 indicates low disease activity Lower than 2.6 indicates disease remission

Number of Rheumatoid Arthritis-related re-hospitalizations between Month 0 and Month 12

Number of adverse effects related to drug treatments leading to hospitalization between Month 0 and Month 12.

The Evolution of the Health Assessment Questionnaire (HAQ) is an 24-item questionnaire.

Each question is assigned the following score:

0 = without any difficulty ; 1 = with some difficulty ; 2 = with great difficulty ; 3 = unable to do so The rating for each of the 8 domains is the one corresponding to the highest score for the questions in that domain.

The notion of need for help from a third person and/or use of devices can modify this rating system. In this case, the score for the area concerned must be at least equal to 2.

The functional index is the sum of the ratings of the various domains divided by the number of domains evaluated (normally 8, but less in case of totally missing data for a particular domain).

The score obtained is between 0 and 3. The higher the score, the more disabling the pathology.

The EuroQol 5-Dimensional score (EQ-5D) is a standardised measure of health-related quality of life.

The EQ-5D descriptive system comprises five dimensions: mobility, self-care, usual activities, pain and discomfort, and anxiety and depression.

The evaluation component requires a patient to record their overall health status using a visual analogue scale (EQ-VAS).

Following assessment the scores from the descriptive component can be reported as a five digit number ranging from 11111 (full health) to 33333/55555 (worst health). A number of methods exist for analysing these five digit profiles. Frequently they are converted to a single utility index using country specific value sets, which can be used in the clinical and economic evaluation of health care as well as in population health surveys.

The Medication Possession Ratio is calculated for each drug: total quantity of dose units dispensed compared to the theoretical quantity of dose units necessary for compliance with the prescribed dosage. The calculation will be made from:

• dispensing data collected from the patient's community pharmacist (control and intervention group),
• prescription data from all prescriptions (between Month 0 and Month 12), reported by the patient during the visit to Month 12,
• and hospitalization data from the medicalized information system program (PMSI:) and the patient log.

The Compliance Questionnaire on Rheumatology (CQR) is a 19 item, self-administered questionnaire that was developed with the aim of correctly identifying patients that were classified as "low" adhering participants (taking <80% of their medication correctly). The four point Likert answering scale ranges from; "Definitely don't agree" (scored 1) to "Definitely agree" (scored 4) with lower scores indicating lower levels of adherence.

The BioSecure questionnaire assess self-management skills and knowledge and patient safety under biotherapy. It has 55 questions regarding 24 areas of competence. The final score is between 0 and 100, a high score reflecting better knowledge.

Questionnaire about Methotrexate assess self-management skills and knowledge and patient safety under Methotrexate. It has 7 questions and 1 scenario (to be chosen by the doctor out of 5). One point is awarded for each correct answer (refer to the correction of the questionnaire). Total out of 100: (score x 100)/ 31. The final score is between 0 and 100, a high score reflecting better knowledge.

Questionnaire about anti-JAK assess self-management skills and knowledge and patient safety under anti-JAK. It has 8 questions and 6 scenario. One point is awarded for each correct answer (refer to the correction of the questionnaire). Total out of 100: sum x 1.92. The final score is between 0 and 100, a high score reflecting better knowledge.

The BMQ consists of two five-item scales assessing patients' beliefs about the necessity of prescribed medication for controlling their disease and their concerns about potential adverse consequences of taking it. Respondents indicate their degree of agreement with each statement on a five-point Likert scale, ranging from 1 = strongly disagree to 5 = strongly agree. Scores obtained for individual items within both scales are summed. Thus, total scores for the Necessity and Concerns Scales range from 5 to 25. Higher scores indicate stronger beliefs.

Costs of managing the two strategies.

Satisfaction of pharmacists and general practitioners through semi-structured interviews at Month 12

Duration of follow-up interviews measured by community pharmacist at Month 2 and Month 6

Number of patients having benefited from a complete follow-up by the town pharmacist (participation in the 2 scheduled meetings to reinforce medication adherence)

Patient satisfaction assessed by a 6_item questionnaire completed by patients in the interventional group.

The 6 items are rated on a 4-dimension Likert-scale : "Not at all satisfied", "Not very satisfied", "Quite satisfied", "Completely satisfied". Answers will be the subject of a descriptive analysis.