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Abstract
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.
Conclusions Our findings suggest that this intervention can be performed with high fidelity in a short amount of time and encourages high quality patient-provider communication. Future work will focus on optimizing provider training and testing the intervention in a larger controlled setting.
Adherence intervention workflow with screenshot of pharmacy refill
Intervention components performed and quality of patient-provider communication during 25 recordings of the adherence intervention
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