Duke University School of Medicine, Durham, North Carolina.
Arthritis Care Res (Hoboken). 2023 Mar;75(3):550-558. doi: 10.1002/acr.24806. Epub 2022 Nov 11.
Despite high rates of medication nonadherence among patients with systemic lupus erythematosus (SLE), effective interventions to improve adherence in SLE are limited. We aimed to assess the feasibility of a pilot intervention and explore its effect on adherence.
The intervention used pharmacy refill data to monitor nonadherence and prompt discussions surrounding SLE medications during clinic encounters. Over 12 weeks, the intervention was delivered through routine clinic visits by providers to patients with SLE who take SLE-specific medications. We measured acceptability, appropriateness, and feasibility using provider surveys. We also measured acceptability by patient surveys and feasibility by medical record documentation. We explored change in adherence by comparing percent of patients with medication possession ratio (MPR) ≥80% 3 months before and after the intervention visit using the McNemar's test.
Six rheumatologists participated; 130 patients were included in the analysis (median age 43, 95% female, and 59% racial and ethnic minorities). Implementation of the intervention was documented in 89% of clinic notes. Provider surveys showed high scores for feasibility (4.7/5), acceptability (4.4/5), and appropriateness (4.6/5). Among patient surveys, the most common reactions to the intervention visit were feeling determined (32%), empowered (32%), and proud (19%). Proportion of patients with MPR ≥80% increased from 48% to 58% (P = 0.03) after the intervention visit.
Our intervention showed feasibility, acceptability, and appropriateness and led to a statistically significant improvement in adherence. Future work should refine the intervention, assess its efficacy in a controlled setting, and adapt its use among other clinic settings.
尽管红斑狼疮（SLE）患者的药物治疗不依从率很高，但改善 SLE 患者依从性的有效干预措施有限。我们旨在评估一项试点干预措施的可行性，并探讨其对依从性的影响。
该干预措施利用药房 refill 数据来监测不依从情况，并在就诊时围绕 SLE 药物进行讨论。在 12 周内，通过提供者对正在服用 SLE 特异性药物的 SLE 患者的常规就诊，提供该干预措施。我们通过提供者调查来衡量可接受性、适当性和可行性。我们还通过患者调查来衡量可接受性，通过医疗记录文件来衡量可行性。我们通过比较干预前后 3 个月的药物占有率（MPR）≥80%的患者比例，来探索依从性的变化，采用 McNemar 检验。
有 6 名风湿病学家参与；对 130 名患者进行了分析（中位数年龄 43 岁，95%为女性，59%为少数族裔）。在 89%的就诊记录中记录了干预措施的实施情况。提供者调查显示，可行性（4.7/5）、可接受性（4.4/5）和适当性（4.6/5）的得分很高。在患者调查中，对干预就诊最常见的反应是感到坚定（32%）、有力量（32%）和自豪（19%）。干预后，MPR≥80%的患者比例从 48%增加到 58%（P=0.03）。
我们的干预措施显示出可行性、可接受性和适当性，并导致依从性的统计学显著改善。未来的工作应进一步完善干预措施，在对照环境中评估其疗效，并适应于其他诊所环境。
