Depression, medication adherence, and service utilization in systemic lupus erythematosus

Abstract

Objective. Forgetting to take medications is an important cause of nonadherence. This study evaluated factors associated with forgetting to take medications in a large cohort of persons with systemic lupus erythematosus (SLE) participating in the University of California, San Francisco Lupus Outcomes Study (LOS). Relationships among adherence problems and service utilization (outpatient visits, emergency department visits, and hospitalizations) were also evaluated. Methods. The cohort consisted of 834 LOS participants who provided self-reported frequency of forgetting to take medications as directed. Predictors of adherence and service utilization patterns included self-reported sociodemographics, disease-related characteristics (e.g., disease activity, recent SLE flare), and mental health characteristics (Center for Epidemiologic Studies Depression Scale and cognitive function screen). Health care utilization patterns included the presence and quantity of visits to rheumatologists, primary care physicians, other care providers, emergency departments, and hospitalizations. Results. Forty-six percent of the LOS cohort reported forgetting to take medications at least some of the time. Depressive symptom severity was a strong predictor of adherence difficulties (odds ratio [OR] 1.04, 95% confidence interval [95% CI] 1.02-1.05; P < 0.0001) after accounting for all other predictors. Persons reporting adherence difficulties had significantly greater numbers of outpatient rheumatology and primary care visits, and were more likely to visit the emergency department (OR 1.45, 95% CI 1.04 -2.04; P ‫؍‬ 0.03). Conclusion. Depression may be an important cause of medication adherence problems, and difficulties with adherence are significantly associated with high-cost service utilization, specifically emergency department visits. In an era of rapidly evolving treatments for lupus, identifying patients at risk for adherence problems may decrease medical expenditures and improve patient outcomes in SLE.

Utilization of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Systemic Lupus Erythematosus Patients: A 13‐Year Population Health Study

“…Previous studies have demonstrated that both are higher in patients with SLE compared to controls (5,10,19,20). The current study confirms this observation, but also demonstrates a consistent change in the pattern of utilization over the 13 years of observation.…”

Prevalência de manifestações clínico-laboratoriais e comorbidades na polimiosite segundo o gênero

“…Depression, particularly in RA, is associated with higher frequency of hospitalization, greater number of medical visits, worse quality of life, lower adherence to drug therapy, and increased risk of mortality. [34][35][36][37] Depression is twice more frequent in women as compared with men, 38 while FM is approximately ten times more prevalent. 39 Our patients with depression showed neither greater disease relapse nor higher incidence of death.…”

Intentional and unintentional treatment nonadherence in patients with systemic lupus erythematosus

“…Treatment adherence in patients with systemic lupus erythematosus (SLE) has been shown to be low, with approximately 30% never failing to take their medications (1)(2)(3), between 20% and 40% stopping their medication on their own (2), and between 14.0% and 42.6% missing one or more clinic visits (1,4 -6). Nonadherence may pose a severe problem, as it has been associated with higher morbidity (5), hospitalization (6), and poor renal outcome (7).…”