Background To optimize medication adherence and outcomes of patients with systemic lupus erythematosus (SLE), we developed an adherence intervention that encourages providers to review real-time pharmacy refill data and use effective communication techniques with patients to collaboratively overcome adherence barriers (figure 1). Prior pilot testing demonstrated intervention feasibility, acceptability, and preliminary effect on adherence. Here we examined areas for improvement to inform future implementation.
Methods We audio recorded clinic encounters between clinicians and patients seen at an academic lupus clinic and included patients with 90-day medication possession ratio (MPR) <80% for SLE-specific medications. We coded which intervention components clinicians performed, quality of patient-provider communication, and time spent discussing adherence. We assessed change in 90-day MPR after the intervention visit. We also conducted audio-recorded semi-structured interviews with patients and clinicians about their experiences with the intervention and analyzed the data using applied thematic analysis.
Results We recorded and analyzed 25 patient encounters (median age 39, 100% female, 72% Black) among six clinicians. Clinicians performed the majority of intervention components in most of encounters (table 1). Global communication scores and rates of active patient participatory behavior were high. Almost half (44%) of patients had a major improvement (>20% increase) in MPR following the intervention visit. Adherence discussions took on average 3.8 minutes, and nearly all patients and providers said the time was ‘just right’. Many patients said they felt heard and valued and described being more honest about nonadherence and more motivated to take SLE medications. A few clinicians wanted additional resources and training to improve adherence conversations.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.