Improving Adherence
Dr. Sun and her colleagues developed an individualized intervention to help university lupus clinic providers better recognize and address nonadherence. Providers and patients examine pharmacy data on how often patients pick up prescriptions. The providers give positive reinforcement to patients who pick up at least 80% of prescriptions. If there are gaps in refills, the providers ask openended questions about the reasons and try to identify and address each patient’s barriers.
In a 12-week pilot involving 134 patients, the researchers compared adherence rates from three months before the intervention to three months after it. Adherence increased from 11% for hydroxychloroquine, 12% for disease-modifying anti-rheumatic drugs and 9% for mycophenolate mofetil. Among 48 patients who completed surveys, no patient reported feeling angry, upset or embarrassed.3 “We’re trying to improve this intervention,” Dr. Sun says.
She notes tactics others can use, like asking open-ended questions about adherence barriers in ways that validate patient experience. “For example, you can say it’s common to miss doses because many people have trouble remembering, paying for the medications or not understanding what they are for. Then ask, ‘Are those ever an issue for you?’”
Have a list of resources patients can use to help overcome particular barriers, such as contact information for social workers who can help with insurance problems. Recommend applications that help with busyness or forgetting doses.
Build trusting relationships with patients by empathizing with them, Dr. Sun adds. Although her study did not examine systemic racism or providers’ implicit bias, she believes these may sometimes play a role in poor medication adherence.4
“Let’s look at how we’re handling clinic encounters with minority patients,” Dr. Sun says. “Equality means everyone gets the same thing, but equity is giving everyone the same opportunity to achieve the same outcomes.”
Deborah Levenson is a writer and editor based in College Park, Md.
References
- Sun K, Corneli AL, Dombeck C, et al. Barriers to taking medications for systemic lupus erythematosus: A qualitative study of racial minority patients, lupus providers, and clinic staff. Arthritis Care Res (Hoboken). 2021 Mar 4;10.1002/acr.24591.
- Sun K, Eudy AM, Criscione-Schreiber LG, et al. Racial disparities in medication adherence between African American and Caucasian patients with systemic lupus erythematosus and their associated factors. ACR Open Rheumatol. 2020 Jul;2(7):430–437.
- Sun K, Rogers J, Sadun R, et al. Intervention to improve SLE medication adherence using Surescripts pharmacy refill data [abstract]. Arthritis Rheumatol. 2020;72(suppl 10).
- Peckham C. Medscape rheumatologist lifestyle report 2017: Race and ethnicity, bias and burnout. 2017 Jan. 11. https://www.medscape.com/features/slideshow/lifestyle/2017/rheumatology#page=1.
