Implementation of a Clinician-led Medication Adherence Intervention Among Patients With Systemic Lupus Erythematosus

作者：Kai Sun, Nneka Molokwu, Emily Hanlen‐Rosado, Amy Corneli, Kathryn I. Pollak, Jennifer L. Rogers, Rebecca E. Sadun, Lisa Criscione‐Schreiber, Jayanth Doss, Hayden B. Bosworth, Megan E. B. Clowse · 发表于：The Journal of Rheumatology · 年份：2024 · DOI：10.3899/jrheum.2024-0071 · 被引用次数：4 · 研究领域：Systemic Lupus Erythematosus Research、Medication Adherence and Compliance、Rheumatoid Arthritis Research and Therapies

OBJECTIVE: Medication nonadherence in systemic lupus erythematosus (SLE) leads to poor clinical outcomes. We developed a clinician-led adherence intervention that involves reviewing real-time pharmacy refill data and using effective communication to address nonadherence. Prior pilot testing showed promising effects on medication adherence. Here, we describe further evaluation of how clinicians implemented the intervention and identify areas for improvement. METHODS: We audio recorded encounters of clinicians with patients who were nonadherent (90-day proportion of days covered [PDC] < 80% for SLE medications). We coded recordings for intervention components performed, communication quality, and time spent discussing adherence. We also conducted semistructured interviews with patients and clinicians on their experiences and suggestions for improving the intervention. We assessed change in 90-day PDC post intervention. RESULTS: We included 25 encounters with patients (median age 39, 100% female, 72% Black) delivered by 6 clinicians. Clinicians performed most intervention components consistently and exhibited excellent communication, as coded by objective coders. Adherence discussions took an average of 3.8 minutes, and 44% of patients had ≥ 20% increase in PDC post intervention. In structured interviews, many patients felt heard and valued and described being more honest about nonadherence and more motivated to take SLE medications. Patients emphasized patient-clinician communi...