Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
Duke Clinical Research Institute, Duke University School of Medicine, Durham NC, USA.
Lupus. 2024 Oct;33(12):1299-1305. doi: 10.1177/09612033241280695. Epub 2024 Sep 3.
Medication nonadherence is common in systemic lupus erythematosus (SLE) and associated with morbidity and mortality. We explored the reliability of pharmacy data within the electronic medical record (EMR) to examine factors associated with nonadherence to SLE medications.
We included patients with SLE who were prescribed ≥1 SLE medication for ≥90 days. We compared two datasets of pharmacy fill data, one within the EMR and another from the vendor who obtained this information from pharmacies and prescription benefit managers. Adherence was defined by medication possession ratio (MPR) ≥80%. In addition to MPR for each SLE medication, we evaluated the weighted-average MPR and the proportion of patients adherent to ≥1 SLE medication and to all SLE medications. We used logistic regression to examine factors associated with adherence.
Among 181 patients (median age 36, 96% female, 58% Black), 98% were prescribed hydroxychloroquine, 34% azathioprine, 33% mycophenolate, 18% methotrexate, and 7% belimumab. Among 1276 pharmacy records, 74% overlapped between linked EMR-pharmacy data and data obtained directly from the vendor. Only 9% were available from the vendor but not through linked EMR-pharmacy data. The weighted-average MPR was 57%; 45% were adherent to hydroxychloroquine, 46% to ≥1 SLE medication, and 32% to all SLE medications. Older age was associated with adherence in univariable and multivariable analyses.
Our study showed that obtaining linked EMR-pharmacy data is feasible with minimal missing data and can be leveraged in future adherence research. Younger patients were more likely to be nonadherent and may benefit from targeted intervention.
在系统性红斑狼疮（SLE）中，药物治疗不依从是很常见的，并且与发病率和死亡率有关。我们探索了电子病历（EMR）中药物记录的可靠性，以研究与 SLE 药物不依从相关的因素。
我们纳入了至少服用 1 种 SLE 药物且服药时间超过 90 天的 SLE 患者。我们比较了 EMR 内的药物填充数据和从药店和处方福利经理处获取信息的供应商的另一个药物填充数据。药物依从性通过药物使用比例（MPR）≥80%来定义。除了每种 SLE 药物的 MPR 之外，我们还评估了加权平均 MPR 和至少服用 1 种 SLE 药物及所有 SLE 药物的患者比例。我们使用逻辑回归来研究与依从性相关的因素。
在 181 名患者中（中位年龄 36 岁，96%为女性，58%为黑人），98%的患者服用羟氯喹，34%的患者服用硫唑嘌呤，33%的患者服用霉酚酸酯，18%的患者服用甲氨蝶呤，7%的患者服用贝利尤单抗。在 1276 份药物记录中，74%的记录在 EMR 链接药物数据和从供应商直接获得的数据中是重叠的。只有 9%的数据可以从供应商处获得，但不能通过 EMR 链接药物数据获得。加权平均 MPR 为 57%；45%的患者对羟氯喹依从，46%的患者对至少 1 种 SLE 药物依从，32%的患者对所有 SLE 药物依从。单变量和多变量分析显示，年龄较大与依从性相关。
我们的研究表明，通过最小的缺失数据获取 EMR 链接药物数据是可行的，并且可以在未来的依从性研究中加以利用。年轻患者更有可能不依从，可能需要针对性的干预。
