Adherence To Medications In Systemic Lupus Erythematosus

Koneru, Sri; Kocharla, Lakshmi P.; Higgins, Gloria C.; Ware, Avis; Passo, Murray H.; Farhey, Yolanda; Mongey, Anne‐Barbara; Graham, T. Brent; Houk, J. Lawrence; Brunner, Hermine I.

doi:10.1097/rhu.0b013e31817a242a

Cited by 99 publications

(129 citation statements)

References 26 publications

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“…This approach is supported by findings from a previous study in which the main self-reported barriers to adherence among SLE patients were examples of unintentional nonadherence (e.g., "just having forgotten" or "being busy at work") (33). In addition, suggestions by these patients on how to improve adherence all referred to actions that are related to preventing unintentional nonadherence (e.g., pill boxes or task lists).…”

Section: Discussionsupporting

confidence: 59%

“…One other study has examined the relationship between age and adherence in SLE and found a nonsignificant tendency for adherent patients to be older than nonadherent patients (33). A similar effect of age on adherence has been reported in a study investigating predictors of adherence in 4 chronic illnesses (37).…”

Section: Discussionsupporting

confidence: 52%

“…Although most studies on treatment adherence in SLE patients have also looked at associations with sociodemographic and psychological factors, only few have used validated questionnaires to measure these variables (1,2,33). Despite this limitation, fear of side effects of medication was an important barrier to adherence in 5 of 6 studies (1,2,8,10,35).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported mixed results on the relationship between ethnicity and adherence levels, and comparison with the present study is limited because prior research involved different ethnic groups. Three studies report a lower self-reported adherence in African Americans compared with whites (2,5,33), but one study used a physician's assessment of adherence (5) and another study only found an effect for hydroxychloroquine, and not for prednisone or other immunosuppressants (33). Studies that involved the same ethnic groups as the present study, but looked at medication adherence in patients with diabetes mellitus, support a poorer medication self-care (38) and lower adherence rates (39) in Pacific peoples compared with Europeans.…”

Section: Discussionmentioning

confidence: 99%

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Intentional and unintentional treatment nonadherence in patients with systemic lupus erythematosus

Daleboudt¹,

Broadbent²,

McQueen³

et al. 2011

Arthritis Care & Research

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Objective. Patients may be defined as nonadherent if they do not take their medications as prescribed by their physicians. Determinants of nonadherence may vary between and within patient groups. This study investigated the extent to which patients with systemic lupus erythematosus (SLE) show intentional and unintentional nonadherence, and the associations of nonadherence with psychological and medical parameters. Methods. The study included 106 patients who were receiving at least one immunosuppressive agent to control their SLE. Level of self-reported adherence and a measure of both intentional and unintentional nonadherence were obtained. Questionnaires were completed to assess associations between adherence and problems with cognitive functioning, beliefs about medicines, illness perceptions, emotional health, and disease characteristics. Results. The mean self-reported adherence rate for the total patient group was 86.7%. At least occasional intentional nonadherence was reported by 46.2% of patients and 58.5% of patients were at least occasionally unintentionally nonadherent. Problems with cognitive functioning, concerns about adverse effects of medication, and younger age were the strongest predictors of (non)adherence. Patients who were emotionally affected by their SLE were more likely to report low adherence, but this was not a significant predictor after accounting for other variables. Disease characteristics showed no relationship to measures of adherence. Conclusion. Although SLE patients reported high levels of adherence on average, they commonly reported intentional and unintentional nonadherence. Adherence was associated with both cognitions and emotions. Nonadherence may be reduced by targeting emotional and cognitive functioning and by fine tuning doctor-patient communication to address patients' individual concerns about their medications.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Intentional and unintentional treatment nonadherence in patients with systemic lupus erythematosus

Daleboudt¹,

Broadbent²,

McQueen³

et al. 2011

Arthritis Care & Research

View full text Add to dashboard Cite

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“…34 Another study, by Koneru et al, of non-adherence in adults of slightly younger age range (33.6±15 years), although not finding young age significant, found busy life style, lack of family or social support as key, together with poor comprehension of instructions and low educational level as significant risk factors. 35 If these few adult studies suggest that educational, cognitive and social status of SLE patients, significantly impacts on treatment adherence, it lends weight to the importance of studying NPSLE in childhood onset SLE in greater depth, where development of these skills and functions, during active childhood disease, could be potentially affected.…”

Section: Normal Cognitive Development In the Developing Child And Adomentioning

confidence: 99%

Pathogenesis of neurocognitive and neuropsychiatric manifestations in childhood-onset lupus: an overview

2014

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This review explores current understanding of neuropsychiatric systemic lupus erythematosus (NPSLE) of childhood onset, in particular neurocognitive impairment. As yet, fewer studies have focused on childhood onset NPSLE compared to adult onset NPSLE and diagnosis still involves the 1999 American College of Rheumatology case definitions of neuropsychiatric syndromes, which were developed for adults. Although a validated core set of neuropsychometric tests exist for childhood onset NPSLE, these still have limitations and possible biomarkers and newer neuroimaging modalities remain mostly experimental. Important differences exist between childhood and adult onset SLE and specifically with NPSLE, outlined in this review. Normal adolescent brain development also involves significant differences from adults, particularly in executive function and social cognition. These issues may impact on the pathogenesis of NPSLE during this vulnerable period and also influence their management options.

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Medication Nonadherence Is Associated With Increased Subsequent Acute Care Utilization Among Medicaid Beneficiaries With Systemic Lupus Erythematosus

Feldman

Yazdany

Guan

et al. 2015

Arthritis Care & Research

103

104

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Objective We examined whether nonadherence to hydroxychloroquine (HCQ) or immunosuppressive medications (IS) was associated with higher subsequent acute care utilization among Medicaid beneficiaries with systemic lupus erythematosus (SLE). Methods We utilized U.S. Medicaid data from 2000–2006 to identify adults 18–64 years with SLE who were new users of HCQ or IS. We defined the index date as receipt of HCQ or IS without use in the prior six months. We measured adherence using the medication possession ratio (MPR), the proportion of days covered by total days supply dispensed, for one-year post-index date. Our outcomes were all-cause and SLE-related emergency department (ED) visits and hospitalizations in the subsequent year. We used multivariable Poisson regression models to examine the association between nonadherence (MPR<80%) and acute care utilization adjusting for sociodemographics and comorbidities. Results We identified 9,600 HCQ new users and 3,829 IS new users with SLE. The mean MPR for HCQ was 47.8% (SD 30.3) and for IS, 42.7% (SD 30.7). 79% of HCQ users and 83% of IS users were nonadherent (MPR<80%). In multivariable models, among HCQ users, the incidence rate ratio (IRR) of ED visits was 1.55 (95% CI 1.43–1.69) and the IRR of hospitalizations was 1.37 (95% CI 1.25–1.50), comparing nonadherers to adherers. For IS users, the IRR of ED visits was 1.64 (95% CI 1.42–1.89) and of hospitalizations was 1.67 (95% CI 1.41–1.96) for nonadherers versus adherers. Conclusion In this cohort, nonadherence to HCQ and IS was common and was associated with significantly higher subsequent acute care utilization.

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Adherence To Medications In Systemic Lupus Erythematosus

Abstract: Although lack of sufficient adherence to medications appears to be a multifactorial problem, improved communication between the healthcare provider and the patient, and less complicated medication regimens, may be especially suitable interventions to improve adherence to medications.

Cited by 99 publications

References 26 publications

Intentional and unintentional treatment nonadherence in patients with systemic lupus erythematosus

Intentional and unintentional treatment nonadherence in patients with systemic lupus erythematosus

Pathogenesis of neurocognitive and neuropsychiatric manifestations in childhood-onset lupus: an overview

Medication Nonadherence Is Associated With Increased Subsequent Acute Care Utilization Among Medicaid Beneficiaries With Systemic Lupus Erythematosus

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