Intentional and unintentional treatment nonadherence in patients with systemic lupus erythematosus

Abstract

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.

A Novel mHealth Approach for a Patient-Centered Medication and Health Management System in Taiwan: Pilot Study (Preprint)

“…Intentional non-adherence refers to deciding not to take a medication based on the patient's own perceptions, feelings or beliefs [7][8][9]. For instance, incomplete medication knowledge may result in fear of adverse side effects and are often the intentional reason for medication non-adherence.…”

“…In contrast, unintentional non-adherence means that the patient intends to take a medication as prescribed but fails to do so because of forgetfulness or carelessness. Patients' demographic and clinical characteristics, complicated regimens associated with polypharmacy, and patient-physician interaction may cause unintentional 6 medication non-adherence [7][8][9][10][11]. Whether it is intentional or unintentional, medication nonadherence leads to poor therapeutic outcomes and the waste of healthcare resources.…”

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

“…One recent study of adults with SLE, with age range of 43.44±14.96 years, has suggested that a young age and cognitive impairment, are two key predictors of non-adherence to treatment in SLE. 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.…”

Exploring the relationship between health beliefs and medication adherence in individuals with asthma

“…180,[184][185][186] Other findings suggest there is not a strong relationship between the understanding subscale and adherence. 64,158,167,169 The cause subscale is usually analysed as a categorical variable. The perceived cause of illness is generally categorised into different factors (e.g.…”

“…64 The extent that cost impacts medication adherence appears less in countries such as Australia where medication is subsidised. 64 Generally, increasing the amount the patient pays compared to the healthcare system (in Australia, the Pharmaceutical Benefits Scheme)…”