Translating research into clinical practice: Quality Improvement to halve non-adherence to Methotrexate

Anne Barton, Meghna Jani, Christine Bundy, James Bluett, Stephen Mcdonald, Brian Keevil, Faraz Dastagir, Melissa Aris, Ian Bruce, Pauline Ho, Eoghan Mccarthy, Ellen Bruce, Benjamin Parker, Kimme Hyrich, Rachel Gorodkin

Research output: Contribution to journalArticlepeer-review


Background: Methotrexate (MTX) remains the cornerstone for therapy for rheumatoid arthritis yet research shows that non-adherence is significant and correlates with response to therapy.

Aim: To halve self-reported non-adherence to MTX at Kellgren Centre for Rheumatology.

Methods: An anonymous self-report adherence questionnaire was developed and data collected for 3 months prior to the introduction of interventions and then regularly for the subsequent 2.5 years. A series of interventions were implemented including motivational interviewing training; consistent information about MTX and development of a summary bookmark. Information on clinic times was collected for consultations with and without motivational interviewing. Surveys were conducted to ascertain consistency of messages about MTX. A biochemical assay was used to test MTX serum levels in patients at two time points: before and 2.8 years following introduction of the changes. Remission rates at 6 and 12 months post-MTX initiation were retrieved from patient notes and cost savings estimated by comparing actual numbers of new biologic starters compared with expected numbers based on the numbers of consultants employed at the two time-points.

Results: Between June and August 2016, self-reported non-adherence to MTX was 24.7%. Following introduction of the interventions, self-reported non-adherence rates reduced to an average of 7.4% between April 2018 and August 2019. Clinic times were not significantly increased when motivational interviewing was employed. Consistency of messages by staff across 3 key areas (benefits of MTX, alcohol guidance and importance of adherence) improved from 64% in September 2016 to 94% in January 2018. Biochemical non-adherence reduced from 56% (Sept 2016) to 17% (June 2019) whilst remission rates 6 months post-initiation of MTX improved from 13% in 2014/15 to 37% in 2017/18, resulting is estimated cost savings of £30,000.00 per year.

Conclusion: Non-adherence to MTX can be improved using simple measures including focusing on the adherence and the benefits of treatment and providing consistent information across departments.
Original languageEnglish
JournalRheumatology (Oxford)
Early online date27 Jun 2020
Publication statusPublished - 27 Jun 2020


  • Methotrexate
  • Adherence
  • quality improvement
  • motivational interviewing


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