Dr Ayano Kelly tells us about why she became a rheumatologist, how her research on adherence benefits her practice and her long-term plan to … run a cat café.
Dr Ayano Kelly is a Sydney rheumatologist who has recently completed a PhD on medication adherence in rheumatology.
Here she tells us about why she became a rheumatologist, how her research on adherence benefits her practice and her long-term plan to … run a cat café.
What areas do you specialise in?
General rheumatology.
Why did you decide to go into rheumatology?
I decided to go into rheumatology when I was working as a basic trainee at Liverpool Hospital. I was doing a rheumatology term and really enjoyed working with the team there. The main reason was that the rheumatologists were very friendly and seemed like some of the happiest specialists that I had come across. I also enjoyed the specialty as you get to build a relationship with patients over time, and I had an interest in managing complex, multisystem conditions.
Tell us about the research you’ve worked on. What are you hoping to achieve with this research?
I have just completed a PhD in the topic of medication adherence in rheumatology. I find it really interesting because adherence relates to human behaviour, and like any behaviour it is complex and there are many factors at play. I was especially interested in what I could do better as a doctor to support people with their medications. I hope that my research can give other clinicians some insights into what patients think and experience in relation to their medications, so that we can better support them.
What have you found out specifically by doing this research?
Other researchers have identified more than 300 reasons people with chronic conditions may not take their medications as prescribed. My research also showed that people with rheumatic conditions have many different barriers to medication taking, and that there are specific issues related to life stage (for example, when transitioning from paediatric care to adult care) and condition.
One of my studies had patients and caregivers with rheumatoid arthritis, osteoporosis and gout describe their barriers and facilitators in focus groups and rank these. Interestingly, out of 49 factors they identified, the top was their trust in their doctor, followed by how effective the medication is, how knowledgeable they felt their doctor was, side effects and having a routine to take medications regularly.
For me, it was a good reminder that the patient-doctor relationship and care we show to our patients is really important, and the experiences of patients in this study and others that I performed made me realise we can do a lot to assist with adherence.
This could include:
- offering multiple options and discussing them
- spending time to talk about medication concerns
- ensuring that, as a whole, different medications people are taking don’t interact with each other and looking at how they impact on a person’s overall well-being and function
- providing more opportunities for feedback on safety and efficacy of medications through blood monitoring
- assisting with habit formation, for example with Webster packs.
What do you wish you’d known at the start of the research project? What have been some of the challenges?
I wish I had known that measuring medication adherence can be difficult. Questionnaires are often inaccurate, and even some objective measures, such as calculating adherence from pharmacy refill scripts, can over-estimate adherence. This is one of the reasons that research in this field can be challenging.
How has covid-19 changed your role?
Luckily, covid-19 hit as I was finishing up my PhD. It was challenging starting a new job as a consultant in the midst of the pandemic as a lot of consultations were via telehealth, without the ability to properly examine people.
Do you think rheumatologists should get more involved in research? Why?
I think clinicians can bring a lot to research from their real-life experiences caring for patients and the challenges they face. Their role also allows them to translate research findings to practical solutions in the clinical setting. I personally learn a lot from patients, especially from doing qualitative research. I have found that even the most experienced rheumatologists are surprised about what we find when we delve further into the patient’s experiences and perspectives through research.
Tell us something about your personal life that your colleagues might not know about
I love to bake and, wherever I work, I try to find an excuse to bake things for people. I also love cats and somehow picked up 12 stray cats from the street during the pandemic – with a lot of help we got them all healthy, de-sexed and re-homed! A few years down the track you may find that I am working as a rheumatologist and running a cat café.
Selected references
Kelly A, Tymms K, Fallon K et al. Qualitative research in rheumatology: an overview of methods and contributions to practice and policy. J Rheumatol. (doi: 10.3899/jrheum.191368).
Gives people who are new to qualitative research an idea of the methods used in this type of research and how to appraise it with some rheumatology examples.
Kelly A, Crimston-Smith L, Tong A et al. Scope of outcomes in trials and observational studies of interventions targeting medication adherence in rheumatic conditions: a systematic review. J Rheumatol. 2020;47(10):1565-74. (doi: 10.3899/jrheum.190726).
This paper reviewed the different trials aiming to improve medication adherence in rheumatic conditions, particularly focused on which outcomes were measured, and how adherence can be measured and reported in many ways. Of more interest to people thinking of doing research in this field.
Kelly A, Tymms K, Tunnicliffe DJ et al. Patients’ attitudes and experiences of disease modifying anti-rheumatic drugs in rheumatoid arthritis and spondyloarthritis: A systematic review of qualitative studies. Arthritis Care Res. 2018;70(4):525-32. (doi: 10.1002/acr.23329).
This is a systematic review of 56 published qualitative studies that were synthesised to describe the experiences and perspectives of patients with RA and SpA of their DMARDs. I think this is an interesting paper for health professionals and patients.
Kelly A, Niddrie F, Tunnicliffe DJ et al. Patients’ attitudes and experiences of transition from paediatric to adult healthcare in rheumatology: a qualitative systematic review. Rheumatology (Oxford). (doi: 10.1093/rheumatology/keaa168).
I learnt a lot from this systematic review of 26 qualitative studies on patients perspectives of transitioning from paediatric to adult care in rheumatology – would be of interest for both paediatric and adult Rheumatology health professionals.
Kelly A, Tymms K, de Wit M et al. Patient and caregiver priorities for medication adherence in gout, osteoporosis and rheumatoid arthritis: nominal group technique. Arthritis Care Res. 2020;72(10):1410-9. (doi: 10.1002/acr.24032).
This is the focus group paper I refer to above. We did 14 focus groups with 82 participants.
