Simpler language, slower speech may improve lupus medication adherence
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Optimizing patient-provider communication and enhancing patient self-efficacy may improve medication adherence rates among patients with systemic lupus erythematosus, according to results presented at the ACR Convergence 2020 meeting.
“Our study confirms prior findings that adherence to lupus medications is quite low,” Ann Cameron Barr, MD, of Duke University Hospital, told attendees. “We found that persistent nonadherence, a subset of nonadherent patients, is disproportionately more common in young Black patients. An important strength of our study is that we assess adherence at two separate time points to find a particularly high-risk group of patients.”
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Barr and colleagues conducted a longitudinal survey and chart review to identify modifiable risk factors for medication nonadherence among patients with SLE. To do this, the researchers identified patients with SLE enrolled in the Duke Registry who were taking one or more medications for their disease. Baseline data were collected between July 2018 and January 2019, and included demographics, self-efficacy, patient-provider communication according to the Interpersonal Processes of Care survey, and Systemic Lupus International Collaborating Clinics (SLICC) damage scores. SLEDAI and physician global assessment scores were collected during follow-up: September 2019 through January 2020.
At both baseline and follow-up, adherence data were collected, including self-reported adherence in the previous month from 0 to 100% (90% = high self-reported adherence), and pharmacy refill data in the previous 3 months (80% medication adherence ratio = high refills), with both high self-reported adherence and high refills equating to high composite adherence. Persistent adherence was defined as patients with high composite adherence at both baseline and follow-up, and persistent nonadherence was defined as those with low composite adherence at baseline and follow-up. Inconsistent adherence was used to define the remainder of patients.
Seventy-seven patients with SLE were included (53% Black, 43% white, 4% other), most of whom were female (96%). The median age was 44 years; 60% reported at least a college education and 51% had private health insurance. Prescriptions included hydroxychloroquine (84%), DMARDs (57%) and belimumab (4%), with patients prescribed two drugs on average.
At baseline, 73% of patients had high self-reported adherence, 51% had high refills and 43% had high persistent adherence. According to longitudinal results, persistent adherence occurred among 32% of patients, persistent nonadherence in 47% and inconsistent adherence in 21%. When compared, patients with persistent nonadherence were younger, more likely to be Black, took more lupus medications and had higher PGA scores, according to Barr. Additionally, these patients reported higher rates of hurried communication, including speaking quickly and using hard words, as well as lower self-efficacy in managing medications and treatments.
“We found that patients with persistent nonadherence rated more hurried patient-provided communication and had lower self-efficacy and medication management,” Barr said. “One limitation of our study was that due to low sample size, we were unable to do a multivariate analysis to confidently identify key predictors of persistent nonadherence. However, the goal of our study was to identify factors associated with medication nonadherence that we can address in clinic.”
She added: “Our results suggest that optimizing patient provider communication and patient self-efficacy and medication management are potential avenues for intervention in this particularly high-risk group.”
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Barr A. Abstract #0439. Presented at: ACR Convergence 2020; November 5-9, 2020 (virtual meeting).
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