Medical adherence in patients with systemic lupus erythematosus in Germany: predictors and reasons for non-adherence – a cross-sectional analysis of the LuLa-cohort

Abstract

Objective Adherence to medication has a major impact on treatment control and success especially in chronic diseases but often remains unrecognized. Besides clinical, socioeconomic, disease-related and treatment-related parameters, general and personal health beliefs, as well as perception of health, can affect adherence. Our aim was to investigate the adherence to lupus-specific medications in German lupus patients and to assess influencing factors including detrimental or beneficial effects of health perceptions and beliefs. Methods The Lupus Erythematosus (LE) Long-Term Study (LuLa-study) is a nationwide longitudinal study among German Caucasian patients with systemic lupus erythematosus who have been assessed annually using a self-reported questionnaire since 2001. In 2013, we included questions concerning medical adherence (Morisky Medication Adherence Scale; MMAS-4), beliefs about medication prescribed (BMQ), illness perception and about the patients' health locus of control (HLC). We present a cross-sectional analysis to assess predictors of adherence using a multivariable stepwise logistic regression. Results Five hundred and seventy-nine patients participated, 81 of whom did not take any lupus-specific medication and 40 of whom did not complete the MMAS-4 and were therefore omitted. Only 62.7% reported high adherence. Unintentional behaviour for low medical adherence exceeded the intentional behaviour by far. The use of azathioprine (OR: 1.85; 95% CI: 1.02-3.34), prednisone <7.5 mg (OR: 1.56; 95% CI: 0.97-2.49), a higher age (OR: 1.06; 95% CI: 1.03-1.08) and higher external HLC (OR: 1.15; 95% CI: 1.01-1.30) proved conducive for high adherence in our multivariable model. On the contrary, the general perception of medication being harmful or addictive (OR: 0.89; 95% CI: 0.82-0.97) was detrimental. Conclusion A low belief that one's own health is determined by healthcare providers (external HLC) and the belief of the harmfulness of medication were independent predictors of low adherence besides age and the choice of the medical agent. The recognition of these potential obstacles in physician-patient relationships is essential to ameliorate adherence. Provision of sufficient information and education might help to reach the best possible outcome.

<p>Different Associations of Intentional and Non-Intentional Non-Adherence Behaviors with Patient Experience with Healthcare and Patient Beliefs in Medications: A Survey of Patients with Chronic Conditions</p>

“…The incidence of non-adherence at any time during a 6-month study of methotrexate use in patients with rheumatoid arthritis was 26%, 3 and only 63% of patients with systemic lupus erythematosus reported high medication adherence in another study. 4 A recent report investigated medication adherence in medical practices in the United Kingdom. It highlights the complexity of the causes of non-adherence and the need to improve adherence, particularly in people with chronic conditions, and concludes that there is a need for more and better research into behavioral patterns and adherence issues in patients with chronic disease.…”

“…One of the factors associated with better adherence was higher age. 4 A cross-sectional survey which analyzed 577 questionnaires from patients with chronic conditions also found that adherent subjects were older. More adherent patients also took more medications, were in better spirits and had greater confidence in, and information about, their treatments.…”

Personal Health Perceptions as Predictors to Medication Adherence in a Prospective Cohort Study Among Patients with Multiple Sclerosis

“…Indeed, a review on adherence in autoimmune conditions also concluded that economic, demographic, and clinical characteristics were only moderately linked to adherence or persistence (21). The ndings on the prospective association of beliefs about medication with adherence and persistence in medication taking is congruent with previous work in other conditions (37)(38)(39). Still, beliefs about medication were scarcely studied among PwMS; the only study that examined adherence to DMTs was cross-sectional and found no association between medication beliefs and adherence (13).…”

Use of Antimalarial Agents Is Associated with Favourable Physical Functioning in Patients with Systemic Lupus Erythematosus

“…Despite the widely known benefits of AMA on SLE disease activity and course, non-adherence remains a major problem [ 14 , 39 , 40 ]. Costedoat-Chalumeau et al found that the most common reasons for AMA treatment discontinuation by patient initiative included the perception of AMA not being an effective treatment and apprehension about potential side-effects [ 41 ].…”