Macko Christopher A, Santos Roger, Ramalingam Nirmala D, Tran Nicole, Zheng Sijie, Chen Patty Pei-Chang
Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Kaiser Permanente East Bay Pharmacy, Oakland, CA, USA.
Perm J. 2024 Sep 16;28(3):84-90. doi: 10.7812/TPP/23.161. Epub 2024 Jul 23.
Lupus nephritis (LN) is the most common cause of kidney injury in systemic lupus erythematosus and associated with higher morbidity and mortality. Low medication adherence correlates with adverse clinical outcomes.
In a large, integrated health system at Kaiser Permanente East Bay Area, the authors identified mycophenolate mofetil (MMF) prescriptions for LN and collected patient demographics, medication adherence, and copay data. They interviewed patients with low medication adherence rates to understand contributing factors, such as side effects, cost, refill processes, and laboratory draws. Adherence was defined as a proportion of days covered at > 80%. The proportion of days covered is the number of days covered by a medication divided by the number of days in a defined period.
Between November 30, 2021, and November 30, 2022, the authors identified 36 patients with LN on MMF. Almost a third (11/36) of these patients were nonadherent to medication. More than half (7/11) of these patients agreed to be interviewed. They identified the following causes of medication nonadherence: forgetfulness (57%, or 4/7), incomplete laboratory work (28%, or 2/7), medication cost (14%, or 1/7), and intentionally missed doses (14%, or 1/7). No patients identified medication side effects as a cause. The median 30-day copay for MMF was $4.55, and 28% (2/7) of patients paid $0 for their medications.
In the authors' integrated health system, 69% of their patients with LN on MMF were adherent to their medication regimen. Forgetfulness was a challenge for the nonadherent patients. Kaiser Permanente East Bay Area provides convenient refills and laboratory draws; this likely facilitates medication adherence.
狼疮性肾炎（LN）是系统性红斑狼疮中最常见的肾损伤原因，与较高的发病率和死亡率相关。药物依从性低与不良临床结局相关。
在凯撒永久医疗集团东湾地区的一个大型综合医疗系统中，作者确定了狼疮性肾炎患者的霉酚酸酯（MMF）处方，并收集了患者的人口统计学数据、药物依从性和自付费用数据。他们采访了药物依从率低的患者，以了解促成因素，如副作用、费用、续方流程和实验室检查。依从性定义为覆盖天数占比>80%。覆盖天数占比是指一种药物覆盖的天数除以规定时间段内的天数。
在2021年11月30日至2022年11月30日期间，作者确定了36例接受霉酚酸酯治疗的狼疮性肾炎患者。这些患者中近三分之一（11/36）未坚持服药。这些患者中有一半以上（7/11）同意接受采访。他们确定了以下药物不依从的原因：健忘（57%，即4/7）、实验室检查未完成（28%，即2/7）、药物费用（14%，即1/7）和故意漏服（14%，即1/7）。没有患者将药物副作用视为原因。霉酚酸酯的30天自付费用中位数为4.55美元，28%（2/7）的患者药物费用为0美元。
在作者的综合医疗系统中，69%接受霉酚酸酯治疗的狼疮性肾炎患者坚持服药。健忘对不依从的患者来说是一个挑战。凯撒永久医疗集团东湾地区提供便捷的续方和实验室检查；这可能有助于提高药物依从性。
