Area‐Level Predictors of Medication Nonadherence Among <scp>US</scp> Medicaid Beneficiaries With Lupus: A Multilevel Study

Feldman, Candace H.; Costenbader, Karen H.; Solomon, Daniel H.; Subramanian, S. V.; Kawachi, Ichiro

doi:10.1002/acr.23721

Cited by 27 publications

(22 citation statements)

References 44 publications

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“…Lower educational level and greater disease activity are associated with increased intentional and non-intentional medication non-adherence. 11,12,20 None of the disease characteristics (disease activity, disease duration, number of comorbidities) were associated with measures of adherence also consistent with the existing literature. 15 Adherence rates for immunosuppressive medications were good (>80%) with rates for mycophenolate mofetil being slightly higher compared to azathioprine (87.7% vs. 83.3%).…”

Section: Discussionsupporting

confidence: 80%

“…Patients were recruited only at one site which is also a centre of excellence for SLE which could have contributed to more favourable outcomes. Perceived costs and evaluation of the healthcare system 20,52 and frequency of medication intake 17,52 that have been reported as predictors of adherence were not evaluated in the present study, nor were objective measures of medication adherence such as tablet counts, diary cards or drug levels. Data on patients’ trust and quality of relationship with their GPs with whom they may have more frequent contact were not collected.…”

Section: Discussionmentioning

confidence: 98%

“…Nevertheless, there is no single or combination of patient characteristics that would reliably and consistently predict non-adherence across a variety of SLE medications. 18–20…”

Section: Introductionmentioning

confidence: 99%

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Physician–patient interaction and medication adherence in lupus nephritis

Georgopoulou

Nel

Sangle

et al. 2020

Lupus

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Objective The quality of physician–patient interaction can have a significant impact on medication adherence. Little is known about this relationship in patients with lupus nephritis. Methods A cross-sectional, quantitative study. Data collected included demographics, current medication, systemic lupus erythematosus disease activity index, medication adherence, beliefs about medicines, shared decision-making, patient–doctor depth of relationship, patient–doctor quality of relationship, interpersonal trust in a physician and illness perceptions. Results Ninety-eight patients with lupus nephritis completed the questionnaires. Logistic regression indicated that medication adherence was significantly predicted by (a) interpersonal trust in a physician (B = 0.85, Wald 3.94, 95% confidence interval (CI) 1.01, 5.44; P = 0.05); (b) timeline cyclical (B = –0.89, Wald 4.95, 95% CI 0.19, 0.90; P < 0.05) and beliefs about the necessity of medicines (B = 0.75, Wald 4.14, 95% CI 1.03, 4.38; P < 0.05). Mediation analysis showed that beliefs about the necessity of medicines significantly mediated the relationship between trust and medication adherence when adjusted for age (B = 0.48, 95% CI 0.06, 1.08; P < 0.01). A further mediation analysis showed that patient–doctor depth of relationship (B = 0.05, 95% CI 0.01, 0.09; P < 0.001), shared decision-making (B = 0.07, 95% CI 0.01, 0.13; P < 0.001) and patient–doctor quality of relationship (B = 0.08, 95% CI 0.01, 0.16; P < 0.001) significantly mediated the relationship between illness coherence and interpersonal trust in a physician. Conclusion The findings highlighted two key elements: (a) the importance of trust in relation to medication adherence; and (b) a good understanding of patients’ illness is linked to a better relationship with their doctor and greater participation in shared decision-making which is associated with increased trust. Tailored psycho-educational interventions could contribute to improving the patient–doctor relationship quality, trust and increased shared decision-making, which, in turn, might improve medication adherence in patients with lupus nephritis.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 98%

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Physician–patient interaction and medication adherence in lupus nephritis

Georgopoulou

Nel

Sangle

et al. 2020

Lupus

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“…A literature review of medication utilisation in SLE found the percentage of non-adherent patients ranged from 43% to 75%, with studies consistently reporting that >50% of patients were non-adherent 28. Studies of specific SLE treatments, many of which are considered the cornerstone of SLE treatment (hydroxychloroquine, azathioprine, mycophenolate mofetil and immunosuppressive medications), have also consistently shown adherence rates of <25% and medication possession ratios well below the accepted threshold of 80% 29–32. Adherence may have been suboptimal due to hospitalisation as belimumab treatment may have been suspended.…”

Section: Discussionmentioning

confidence: 99%

Real-world treatment patterns, healthcare resource utilisation and costs in patients with systemic lupus erythematosus treated with belimumab: a retrospective analysis of claims data in the USA

Bell

Priest²,

Stott-Miller

et al. 2020

Lupus Sci Med

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ObjectiveTo examine the effects of belimumab initiation on healthcare resource utilisation (HCRU) and costs in SLE.MethodsThis retrospective observational cohort study used healthcare administrative claims data from the IBM MarketScan Commercial Claims and Encounters Database to identify patients with SLE billing codes who received ≥1 intravenous belimumab infusion between March 2011 and December 2015. The first belimumab administration was the ‘index date’. During the 6-month postindex period, nine belimumab infusions were recommended: three during the initiation period and six during the maintenance period. HCRU and cost data for inpatient admissions, emergency department visits, physician office visits, hospital-based outpatient visits, laboratory services, other outpatient services and outpatient pharmacy prescriptions were compared in the 6-month pre/postindex periods.ResultsOf the 1879 patients with SLE included, 43% received ≥3 intravenous initiation administrations. An average of 5.3 (SD: 2.4) of the nine recommended belimumab administrations were received within 6 months. In the 6-month preindex versus postindex periods, significant reductions were noted for inpatient hospitalisations (18% vs 9%, p<0.001; mean visits: 0.3 vs 0.14, p<0.001) and emergency department visits (40% vs 24%, p<0.001; mean visits; 3.53 vs 1.96, p<0.001). Mean total costs were higher in the 6-month postindex versus preindex period ($41 426 vs $29 270; p<0.001).ConclusionsIn this study of real-world intravenous belimumab for SLE, adherence to recommended infusion schedules was low. Outpatient healthcare and associated costs were higher in the 6 months after belimumab was initiated, although inpatient costs were lower. Reasons for non-adherence with belimumab and implications should be investigated.

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“…Given the growing body of evidence indicating low treatment adherence in lupus [20,32,33], recent efforts have examined large Medicaid data to assess disparities in lupus medication adherence [34,35,36]. Among over 10 000 US Medicaid beneficiaries who met the case definition of SLE and initiated hydroxychloroquine, only 15% were classified as adherent [34]. Adherence was lower in geographic areas with higher percentages of black individuals [highest tertile OR 0.81 (0.69–0.96) versus lowest].…”

Section: Other Research Targeting High-risk Populations With Systemicmentioning

confidence: 99%

Update on lupus epidemiology: advancing health disparities research through the study of minority populations

Drenkard

Lim

2019

Current Opinion in Rheumatology

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Purpose of reviewThe current review focuses on recent population-based studies that have examined the burden of lupus, disease outcomes, and gaps in quality of care, with an emphasis in research addressing health disparities.Recent findingsThe Centers for Disease Control and Prevention National Lupus Registries underscored higher susceptibility of both systemic lupus erythematosus (SLE) and primary cutaneous lupus among people of color, compared with whites. Not only does SLE disproportionately strike people from racial and ethnic minorities, those individuals are also at increased risk of developing severe manifestations following SLE diagnosis. Mortality is higher and death occurs at a younger age among blacks, compared with whites. Furthermore, ongoing Centers for Disease Control and Prevention-supported population-based lupus cohorts, along with research by other groups, have provided new insight into the role of social determinants on outcomes and opportunities to improve care in diverse lupus populations.SummaryWhile descriptive epidemiological efforts have been critical to providing more accurate estimates of the burden and mortality of lupus across diverse demographic groups, emerging research suggests a significant influence of psychosocial and healthcare system factors on disease outcomes. These current efforts represent important steps toward the development of clinical and public health interventions aimed at eliminating health disparities in lupus populations.

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Area‐Level Predictors of Medication Nonadherence Among US Medicaid Beneficiaries With Lupus: A Multilevel Study

Cited by 27 publications

References 44 publications

Physician–patient interaction and medication adherence in lupus nephritis

Physician–patient interaction and medication adherence in lupus nephritis

Real-world treatment patterns, healthcare resource utilisation and costs in patients with systemic lupus erythematosus treated with belimumab: a retrospective analysis of claims data in the USA

Update on lupus epidemiology: advancing health disparities research through the study of minority populations

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