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Barriers to medication adherence and degree of nonadherence in a systemic lupus erythematosus (SLE) outpatient population

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Abstract

To estimate the level of medication adherence and barriers to adherence among systemic lupus erythematosus (SLE) patients. Patients taking antimalarials, immunosuppressives, and/or steroids to treat SLE were included. Adherence was measured using the Medication Adherence Self Report Inventory (MASRI) and adherence rates < 80% were considered nonadherent while rates ≥ 80% sufficiently adherent. Pill counts were conducted in a proportion of participants. Barriers to adherence were identified using the Identification of Medication Adherence Barriers Questionnaire 30 (IMAB-Q 30). Associations between adherence and patient demographics and disease-specific characteristics were explored. A total of 94 patients were studied and 28 pill counts conducted. 10 patients were classified as nonadherent and 84 patients as sufficiently adherent. 46% of patients were taking steroids, 77.7% antimalarials, and 55.3% immunosuppressives. 88% of patients were taking ≥ 1 medication for non-SLE conditions. The mean medication adherence rate for the SLE patients was 90.7%. Important barriers to adherence reported by nonadherent patients were: concern about harmful side effects (50%), being easily distracted (50%), life getting in the way (50%), being unsure or disagreeing that their condition will worsen without medications (50%), and having personal reasons for not taking medications (50%). Non-adherent patients reported significantly more barriers than sufficiently adherent patients (p < 0.001). The adherence rate in our population was higher than expected, reaching 90%. Barriers to medication adherence were identified and should be addressed on a population and individualized basis to improve patient outcomes.

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References

  1. Lupus Canada (2020) Lupus Q&A: ask the experts. Lupus Canada. https://lupuscanada.org/living-with-lupus/lupus-qa-ask-the-experts/. Accessed 14 Aug 2020

  2. Lupus Canada (2020) Lupus medications. Lupus Canada. Available from https://lupuscanada.org/resources/fact-sheets/lupus-medications/. Accessed 14 Aug 2020

  3. Koneru S, Kocharla L, Higgins GC, Ware A, Passo MH, Farhey YD, Mongey AB, Graham TB, Houk JL, Brunner HI (2008) Adherence to medications in systemic lupus erythematosus. J Clin Rheumatol 14:195–201

    Article  Google Scholar 

  4. Julian LJ, Yelin E, Yazdany J, Panopalis P, Trupin L, Criswell LA, Katz P (2009) Depression, medication adherence, and service utilization in systemic lupus erythematosus. Arthritis Rheum 61:240–246

    Article  Google Scholar 

  5. Rojas-Serrano J, Cardiel MH (2000) Lupus patients in an emergency unit. Causes of consultation, hospitalization and outcome. A cohort study. Lupus 9:601–606

    Article  CAS  Google Scholar 

  6. Feldman CH, Yazdany J, Guan H, Solomon DH, Costenbader KH (2015) Medication nonadherence is associated with increased subsequent acute care utilization among Medicaid beneficiaries with systemic lupus erythematosus. Arthritis Care Res 67:1712–1721

    Article  CAS  Google Scholar 

  7. Chehab G, Sauer GM, Richter JG, Brinks R, Willers R, Fischer-Betz R, Winkler-Rohlfing B, Schneider M (2018) Medical adherence in patients with systemic lupus erythematosus in Germany: predictors and reasons for non-adherence—a cross-sectional analysis of the LuLa-cohort. Lupus 27:1652–1660

    Article  CAS  Google Scholar 

  8. Mehat P, Atiquzzaman M, Esdaile JM, AviÑa-Zubieta A, De Vera MA (2017) Medication nonadherence in systemic lupus erythematosus: a systematic review. Arthritis Care Res 69:1706–1713

    Article  Google Scholar 

  9. Oliveira-Santos M, Verani JF, Klumb EM, Albuquerque EM (2011) Evaluation of adherence to drug treatment in patients with systemic lupus erythematosus in Brazil. Lupus 20:320–329

    Article  CAS  Google Scholar 

  10. Abdul-Sattar AB, Abou El Magd SA (2015) Determinants of medication non-adherence in Egyptian patients with systemic lupus erythematosus: Sharkia Governorate. Rheumatol Int 35:1045–1051

    Article  CAS  Google Scholar 

  11. Garcia-Gonzalez A, Richardson M, Popa-Lisseanu MG, Cox V, Kallen MA, Janssen N, Ng B, Marcus DM, Reveille JD, Suarez-Almazor ME (2008) Treatment adherence in patients with rheumatoid arthritis and systemic lupus erythematosus. Clin Rheumatol 27:883–889

    Article  Google Scholar 

  12. Liu LH, Fevrier HB, Goldfien R, Hemmerling A, Herrinton LJ (2019) Understanding nonadherence with hydroxychloroquine therapy in systemic lupus erythematosus. J Rheumatol 46:1309–1315

    Article  Google Scholar 

  13. Koneru S, Shishov M, Ware A, Farhey Y, Mongey AB, Graham TB, Passo MH, Houk JL, Higgins GC, Brunner HI (2007) Effectively measuring adherence to medications for systemic lupus erythematosus in a clinical setting. Arthritis Care Res 57:1000–1006

    Article  Google Scholar 

  14. University of Toronto Lupus Clinic (2007) Newsletter issue 5. Toronto Western Hospital. http://wwwstudies.uhnresearch.ca/ cpsrd/lupus/SLE_NL032007.pdf. Accessed 15 July 2020

  15. Tan EM, Cohen AS, Fries JF et al (1982) The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 25:1271

    Article  CAS  Google Scholar 

  16. Lam WY, Fresco P (2015) Medication adherence measures: an overview. BioMed Research International 2015: 217047. https://pubmed.ncbi.nlm.nih.gov/26539470/. Accessed 8 July 2020

  17. Walsh JC, Mandalia S, Gazzard BG (2002) Responses to a 1 month self-report on adherence to antiretroviral therapy are consistent with electronic data and virological treatment outcome. AIDS 16:269–277

    Article  Google Scholar 

  18. Easthall C, Taylor N, Bhattacharya D (2019) Barriers to medication adherence in patients prescribed medicines for the prevention of cardiovascular disease: a conceptual framework. Int J Pharm Pract 27:223–231

    Article  Google Scholar 

  19. Costedoat-Chalumeau N, Houssiau F, Izmirly P, Guern VL, Navarra S, Jolly M, Ruiz-Irastorza G, Baron G, Hachulla E, Agmon-Levin N, Shoenfeld Y (2019) A prospective international study on adherence to treatment in 305 patients with flaring SLE: assessment by drug levels and self-administered questionnaires. Clin Pharmacol Ther 106(2):374–382

    Article  CAS  Google Scholar 

  20. Hardy C, Gladman D, Su J, Rozenbojm N, Urowitz M (2020) Barriers to medication adherence and degree of nonadherence in a systemic lupus erythematosus (SLE) outpatient population. Arthritis Rheumatol 72 (suppl 10). https://acrabstracts.org/abstract/barriers-to-medication-adherence-and-degree-of-nonadherence-in-a-systemic-lupus-erythematosus-outpatient-population/. Accessed 9 May 2021

  21. Harry O, Crosby LE, Smith AW, Favier L, Aljaberi N, Ting TV, Huggins JL, Modi AC (2019) Self-management and adherence in childhood-onset systemic lupus erythematosus: what are we missing? Lupus 28:642–650

    Article  CAS  Google Scholar 

  22. Farmer KC (1999) Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther 21:1074–1090

    Article  CAS  Google Scholar 

  23. Matsui D, Hermann C, Klein J, Berkovitch M, Olivieri N, Koren G (1994) Critical comparison of novel and existing methods of compliance assessment during a clinical trial of an oral iron chelator. J Clin Pharmacol 34:944–949

    Article  CAS  Google Scholar 

  24. Stirratt MJ, Dunbar-Jacob J, Crane HM, Simoni JM, Czajkowski S, Hilliard ME, Aikens JE, Hunter CM, Velligan DI, Huntley K, Ogedegbe G (2015) Self-report measures of medication adherence behavior: recommendations on optimal use. Transl Behav Med 5:470–482

    Article  Google Scholar 

  25. Vik SA, Maxwell CJ, Hogan DB (2004) Measurement, correlates, and health outcomes of medication adherence among seniors. Ann Pharmacother 38:303–312

    Article  Google Scholar 

  26. Daleboudt GM, Broadbent E, McQueen F, Kaptein AA (2011) Intentional and unintentional treatment nonadherence in patients with systemic lupus erythematosus. Arthritis Care Res 63(3):342–350

    Google Scholar 

  27. Zhang L, Luan W, Geng S, Ye S, Wang X, Qian L, Ding Y, Li T, Jiang A (2019) Lack of patient education is risk factor of disease flare in patients with systemic lupus erythematosus in China. BMC Health Serv Res 19:378

    Article  Google Scholar 

  28. Brown T, Twigg M, Taylor N, Easthall C, Hartt J, Budd T, Zhicheng L, Dima A, Bhattacharya D (2017) Final report for the IMAB-Q study: validation and feasibility testing of a novel questionnaire to identify barriers to medication adherence. Pharmacy Research UK, London

    Google Scholar 

  29. Mosley-Williams A, Lumley MA, Gillis M, Leisen J, Guice D (2002) Barriers to treatment adherence among African American and white women with systemic lupus erythematosus. Arthritis Rheumatol 47:630–638

    Article  Google Scholar 

  30. Costedoat-Chalumeau N, Pouchot J, Guettrot-Imbert G, Le Guern V, Leroux G, Marra D, Morel N, Piette JC (2013) Adherence to treatment in systemic lupus erythematosus patients. Best Pract Res Clin Rheumatol 27:329–340

    Article  Google Scholar 

  31. Petri M, Perez-Gutthann S, Longenecker JC, Hochberg M (1991) Morbidity of systemic lupus erythematosus: role of race and socioeconomic status. Am J Med 91:345–353

    Article  CAS  Google Scholar 

  32. Michie S, Johnston M, Francis J, Hardeman W, Eccles M (2008) From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol 57:660–680

    Article  Google Scholar 

  33. Osterberg L, Blaschke T (2005) Adherence to medication. N Engl J Med 353:487–497

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. University of Toronto, Toronto, ON, Canada

    Courtney Hardy

  2. Centre for Prognosis Studies in Rheumatic Diseases, Toronto Western Hospital, University of Toronto Lupus Clinic, University Health Network, 399 Bathurst St. 1E-410B, Toronto, ON, M5T 2S8, Canada

    Dafna D. Gladman, Jiandong Su, Nathalie Rozenbojm & Murray B. Urowitz

  3. Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada

    Courtney Hardy, Dafna D. Gladman, Jiandong Su, Nathalie Rozenbojm & Murray B. Urowitz

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  1. Courtney Hardy
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  2. Dafna D. Gladman
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Correspondence to Murray B. Urowitz.

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Hardy, C., Gladman, D.D., Su, J. et al. Barriers to medication adherence and degree of nonadherence in a systemic lupus erythematosus (SLE) outpatient population. Rheumatol Int 41, 1457–1464 (2021). https://doi.org/10.1007/s00296-021-04898-0

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