Ab0081 Significance of Non-Adherence in a Tertiary Hospital in Mexico: Pre and Post-Pandemic Impact

Background: Non- attendance to medical appointments and poor adherence to treatment negatively impact the control of rheumatic diseases (RD), increasing the risk of complications and healthcare costs[1]. Objectives: This study aims to assess reasons for non-adherence to disease-modifying drugs (DMARDs) and non-attendance in appointments and to identify underlying causes before and after the pandemic. Methods: An observational cross-sectional study was conducted. We included patients ≥18 years old with a diagnosis of RD who attended both follow-up and initial assessments at the "Dr. José Eleuterio González" University Hospital during the period May to September 2023 and agreed to participate in the study. Those who missed their appointments were contacted to evaluate the reason for non-attendance. A questionnaire evaluated DMARDs taken, adherence to them, and reasons for non-adherence. Adherence was categorized based on intake frequency: Good >75% of the time (>21 days), regular 50-74% (15-21 days), poor 25-49% (8-14 days), null <25% (7 days or less). To compare adherence during the COVID-19 pandemic, we used a database covering rheumatology patients from 2021 to 2022. Results: A total of 4,289 patients were scheduled for assessment and 2,078 (48.44%) did not attend. Of this group, 354 patients had a first appointment scheduled, and 1,724 had a follow-up. During this same period, 78 patients were hospitalized, 73% attended follow-up, 23% did not attend and 4% died. Economic factors were the main cause of non-attendance (70%), followed by transportation (14%), forgetting (9%), and personal reasons (2%). Of the 161 patients evaluated for adherence to DMARDs, 135 (83.8%) considered adherence to be good. Hydroxychloroquine was the most common DMARD used by 34% of the patients, followed by methotrexate 29%, prednisone 16%, leflunomide 8%, mycophenolate mofetil 8%, azathioprine 3% with, and sulfasalazine 2%. The non-adherence reasons during 2021 and 2023 are shown in Table 1. Conclusion: Non-attendance and adherence to DMARDs depend on economic and social circumstances. Probably because the study was conducted in a developing country, it is worthwhile to rethink the cost/benefit ratio of the drugs prescribed at the assessment. New strategies are needed to recover patients who stopped attending our service. REFERENCES: [1] Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J. 2011;26(3):155-159. Acknowledgements: NIL. Disclosure of Interests: None declared.