Construction and application of a pharmacy service model for rheumatoid arthritis patients guided by protection motivation theory

Zhu Lirong; Luo Yi; Xu Wei; Liu Jin; Luo Shao; Shi Ying; He Xiong

doi:10.11986/j.issn.1673-873X.2025.07.17

Abstract：Objective To explore the effects of a pharmacy service model based on protection motivation theory(PMT)on dis-ease activity,medication adherence,and self-management level in patients with rheumatoid arthritis(RA),and to provide a reference for optimizing pharmacist-led chronic disease management.Methods 160 RA outpatients who attended the Ninth Peo-ple's Hospital of Chongqing from March to April 2024 were enrolled and randomized,80 per each.The intervention group received PMT-based pharmacy services,while the control group received routine pharmacy services.Changes in subscale scores of the PMT scale at different time points before and after the intervention were analyzed,and disease activity,self-management level,and medica-tion adherence were compared between groups before and after intervention.Meanwhile,the incidence of adverse drug reaction(ADR)in the two groups at different intervention time perioda was compared.Results A total of 141 patients completed three follow-ups(72 in the intervention group,69 in the control group).The PMT subscales of perceived susceptibility,perceived severity,self-efficacy and response efficacy were significantly positively correlated with Self-Management Behavior Scale scores and Morisky Medication Adherence Scale-8(MMAS-8)medication compliance scores,and significantly negatively correlated with Disease Activity Score in 28 Joints(DAS28;P＜0.05);by contrast,internal reward,external reward and response cost were significantly negatively correlated with Self-Management Behavior Scale scores and MMAS-8 scores,and significantly positively correlated with DAS28(P＜0.05).PMT subscale scores showed significant effects of time,group,and time-group interaction(P＜0.05).Before intervention,there were no significant differences between groups in PMT subscale scores(P＞0.05);at month 3,the intervention group outperformed the control group significantly on six PMT subscales(all except self-efficacy;P＜0.05),and at months 6 and 9,the intervention group's PMT subscale scores were superior to the control group's,with statistical significance(P＜0.05).There were no significant differences between groups in ADR incidence across the interven-tion periods(P＞0.05).Before intervention,DAS28,Self-Management Behavior Scale,and MMAS-8 scores did not differ significantly between groups(P＞0.05).After intervention,the intervention group showed significantly better DAS28,self-management,and MMAS-8 scores than the control group(P＜0.05);within-group comparisons showed the intervention group improved significantly on all three measures after intervention(P＜0.05),whereas the control group showed significant improvement only in the Self-Management Behavior Scale(P＜0.05).Conclusion PMT-based pharmacy services help RA pa-tients develop protective motivations,promote medication compliance and self-management levels,and reduce disease activity.This practice provides useful evidence for pharmacists to leverage their professional role in chronic disease management.