Lucy H Liu1,2, Helene B Fevrier1,2, Robert Goldfien1,2, Anke Hemmerling1,2, Lisa J Herrinton3,4. 1. From the Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland; Department of Medicine, Division of Rheumatology, University of California, San Francisco; Division of Research, and Department of Rheumatology, Kaiser Permanente Northern California, Oakland; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco, San Francisco, California, USA. 2. L.H. Liu, MD, MPH, Department of Medicine, Kaiser Permanente Oakland Medical Center, and Department of Medicine, Division of Rheumatology, University of California, San Francisco; H.B. Fevrier, MSPH, MS, Division of Research, Kaiser Permanente Northern California; R. Goldfien, MD, Department of Rheumatology, Kaiser Permanente Northern California; A. Hemmerling, MD, PhD, MPH, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco; L.J. Herrinton, PhD, Division of Research, Kaiser Permanente Northern California. 3. From the Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland; Department of Medicine, Division of Rheumatology, University of California, San Francisco; Division of Research, and Department of Rheumatology, Kaiser Permanente Northern California, Oakland; Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco, San Francisco, California, USA. Lisa.Herrinton@kp.org. 4. L.H. Liu, MD, MPH, Department of Medicine, Kaiser Permanente Oakland Medical Center, and Department of Medicine, Division of Rheumatology, University of California, San Francisco; H.B. Fevrier, MSPH, MS, Division of Research, Kaiser Permanente Northern California; R. Goldfien, MD, Department of Rheumatology, Kaiser Permanente Northern California; A. Hemmerling, MD, PhD, MPH, Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco; L.J. Herrinton, PhD, Division of Research, Kaiser Permanente Northern California. Lisa.Herrinton@kp.org.
Abstract
OBJECTIVE: Hydroxychloroquine (HCQ) is a cornerstone to managing systemic lupus erythematosus (SLE), yet adherence to medication is poor. We sought to measure the association of adherence with 5 "dimensions of adherence" as articulated by the World Health Organization for chronic conditions: the patient's socioeconomic status, and patient-, condition-, therapy-, and healthcare system-related factors. Our longterm goal is to generate evidence to design effective interventions to increase adherence. METHODS: The retrospective cohort study included Kaiser Permanente Northern California patients ≥ 18 years old during 2006-2014, with SLE and ≥ 2 consecutive prescriptions for HCQ. Adherence was calculated from the medication possession ratio and dichotomized as < 80% versus ≥ 80%. Predictor variables were obtained from the electronic medical record and census data. We used multivariable logistic regression to estimate adjusted OR and 95% CI. RESULTS: The study included 1956 patients. Only 58% of patients had adherence ≥ 80%. In adjusted analyses, socioeconomic variables did not predict adherence. Increasing age (65-89 yrs compared with ≤ 39 yrs: OR 1.44, 95% CI 1.07-1.93), white race (p < 0.05), and the number of rheumatology visits in the year before baseline (≥ 3 compared with 0 or 1: OR 1.47, 95% CI 1.18-1.83) were positively associated with adherence. The rheumatologist and medical center providing care were not associated with adherence. CONCLUSION: At our setting, as in other settings, about half of patients with SLE were not adherent to HCQ therapy. Differences in adherence by race/ethnicity suggest the possibility of using tailored interventions to increase adherence. Qualitative research is needed to elucidate patient preferences for adherence support.
OBJECTIVE:Hydroxychloroquine (HCQ) is a cornerstone to managing systemic lupus erythematosus (SLE), yet adherence to medication is poor. We sought to measure the association of adherence with 5 "dimensions of adherence" as articulated by the World Health Organization for chronic conditions: the patient's socioeconomic status, and patient-, condition-, therapy-, and healthcare system-related factors. Our longterm goal is to generate evidence to design effective interventions to increase adherence. METHODS: The retrospective cohort study included Kaiser Permanente Northern Californiapatients ≥ 18 years old during 2006-2014, with SLE and ≥ 2 consecutive prescriptions for HCQ. Adherence was calculated from the medication possession ratio and dichotomized as < 80% versus ≥ 80%. Predictor variables were obtained from the electronic medical record and census data. We used multivariable logistic regression to estimate adjusted OR and 95% CI. RESULTS: The study included 1956 patients. Only 58% of patients had adherence ≥ 80%. In adjusted analyses, socioeconomic variables did not predict adherence. Increasing age (65-89 yrs compared with ≤ 39 yrs: OR 1.44, 95% CI 1.07-1.93), white race (p < 0.05), and the number of rheumatology visits in the year before baseline (≥ 3 compared with 0 or 1: OR 1.47, 95% CI 1.18-1.83) were positively associated with adherence. The rheumatologist and medical center providing care were not associated with adherence. CONCLUSION: At our setting, as in other settings, about half of patients with SLE were not adherent to HCQ therapy. Differences in adherence by race/ethnicity suggest the possibility of using tailored interventions to increase adherence. Qualitative research is needed to elucidate patient preferences for adherence support.
Authors: Kai Sun; Amanda M Eudy; Jennifer L Rogers; Lisa G Criscione-Schreiber; Rebecca E Sadun; Jayanth Doss; Mithu Maheswaranathan; Ann Cameron Barr; Lena Eder; Amy L Corneli; Hayden B Bosworth; Megan E B Clowse Journal: Arthritis Care Res (Hoboken) Date: 2021-11-05 Impact factor: 5.178
Authors: Celline C Almeida-Brasil; John G Hanly; Murray Urowitz; Ann Elaine Clarke; Guillermo Ruiz-Irastorza; Caroline Gordon; Rosalind Ramsey-Goldman; Michelle Petri; Ellen M Ginzler; D J Wallace; Sang-Cheol Bae; Juanita Romero-Diaz; Mary Anne Dooley; Christine Peschken; David Isenberg; Anisur Rahman; Susan Manzi; Søren Jacobsen; Sam Lim; Ronald F van Vollenhoven; Ola Nived; Andreas Jönsen; Diane L Kamen; Cynthia Aranow; Jorge Sanchez-Guerrero; Dafna D Gladman; Paul R Fortin; Graciela S Alarcón; Joan T Merrill; Kenneth Kalunian; Manuel Ramos-Casals; Kristján Steinsson; Asad Zoma; Anca Askanase; Munther A Khamashta; Ian N Bruce; Murat Inanc; Michal Abrahamowicz; Sasha Bernatsky Journal: Ann Rheum Dis Date: 2021-12-15 Impact factor: 27.973
Authors: Narsis Daftarian; Adriana Lima; Shelby Marozoff; Dami Ojo; Steve D Levasseur; David A L Maberley; Alison Hoens; John Esdaile; Martin Dawes; J Antonio Aviña-Zubieta; Beatrice Adante; Ravinder Dennis Bhui; Suruchi B Bhui; Michael Butler; Lica Chui; Murray Erasmus; Mahyar Etminan; Derek Godinho; Elizabeth Hay; Hussein Hollands; Malvinder Hoonjan; Aaron Joe; Andrew Lukaris; Zaid Mammo; Eduardo Navajas; Kaivon Pakzad-Vaezi; Suren Sanmugasunderam; Kam Shojania Journal: BMJ Open Date: 2022-02-17 Impact factor: 2.692