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Gibson S, Johnson N, Simpson Brown S, Hartley S, Maloney K, Gossell-Williams M, Hunter T. Pregnancy outcomes in systemic lupus erythematosus: experience from a Caribbean center. J Matern Fetal Neonatal Med 2023; 36:2204392. [PMID: 37127567 DOI: 10.1080/14767058.2023.2204392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Systemic Lupus Erythematosus (SLE) is a chronic autoimmune multi-system disorder frequently affecting black women of childbearing age. No published data exist on the obstetric outcomes in a Caribbean population. OBJECTIVE We analyzed pregnancy outcomes in an Afro-Caribbean cohort of women with SLE at a tertiary university hospital. METHODS A retrospective cohort study was performed of all pregnant women with SLE prior to pregnancy from January 1990 to December 2021 at the University Hospital of the West Indies (UHWI), Jamaica. Maternal rheumatologic, obstetric, fetal/neonatal data were analyzed. Descriptive statistical analyses were performed. To determine if outcomes were associated with various factors, Spearman's rho was followed by logistic regression analysis to estimate unadjusted odds ratios with statistical significance at p < 0.05. RESULTS A total of 56 pregnancies in 47 women were identified with SLE. Live births were 87.5%, with 10.7% spontaneous miscarriages and no neonatal deaths. Prednisone was the most used drug in 67.9% of patients. 85% of women had an adverse outcome with an adverse fetal outcome occurring in 55% of cases. Prednisone was associated with an adverse fetal/neonatal outcome (Spearman's rho = 0.38; p = .004). CONCLUSION In this first Caribbean series on SLE in pregnancy, reasonably successful pregnancy outcomes are achievable in Afro-Caribbean women managed in multidisciplinary centers.
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Affiliation(s)
- Shanea Gibson
- Department of Obstetrics and Gynaecology, University of the West Indies, Mona, Kingston
| | - Nadine Johnson
- Department of Obstetrics and Gynaecology, University of the West Indies, Mona, Kingston
| | - Simone Simpson Brown
- Department of Obstetrics and Gynaecology, University of the West Indies, Mona, Kingston
| | - Shwantay Hartley
- Department of Basic Medical Sciences, University of the West Indies, Mona, Kingston
| | - Keisha Maloney
- Department of Medicine, University of the West Indies, Mona, Kingston
| | | | - Tiffany Hunter
- Department of Obstetrics and Gynaecology, University of the West Indies, Mona, Kingston
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Garg S, Ferguson S, Chewning B, Gomez S, Keevil J, Bartels C. Clarifying misbeliefs about hydroxychloroquine (HCQ): developing the HCQ benefits versus harm decision aid (HCQ-SAFE) per low health literacy standards. Lupus Sci Med 2023; 10:e000935. [PMID: 37500292 PMCID: PMC10387621 DOI: 10.1136/lupus-2023-000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Up to 83% of patients with SLE stop taking hydroxychloroquine (HCQ) within the first year due to knowledge gaps regarding the survival benefits of HCQ versus inflated fears of rare toxicity. Thus, there is a need for a shared decision-making tool that highlights HCQ's significant benefits versus rare harms to improve patients' understanding and align treatments with their values. The objective of this study was to describe development and piloting of a decision aid (HCQ-SAFE) to facilitate HCQ adherence, and safe, effective use by engaging patients in therapeutic decision-making. METHODS HCQ-SAFE was developed via a collaborative process involving patients, clinicians, implementation scientists and health literacy experts. The initial prototype was informed by Agency for Healthcare Research and Quality (AHRQ) low literacy principles and key themes about HCQ use from six prior patient and clinician focus groups, with iterative expert and stakeholder feedback to deliver a final prototype. We implemented HCQ-SAFE in four clinics to examine usability and feasibility on Likert scales (0-7) and net promoter score (0%-100%). RESULTS The final HCQ-SAFE shared decision-making laminated tool organises data using pictograms showing how HCQ use reduces risk of organ damage, early death and blood clots versus low risk of eye toxicity.HCQ-SAFE was reviewed in all eligible patient visits (n=40) across four clinics on an average of ~8 min, including 25% non-English-speaking patients. All patients scored 100% on the knowledge post-test; no decisional conflicts were noted after using HCQ-SAFE. HCQ-SAFE garnered high clinician and patient satisfaction with 100% likelihood to recommend to peers. CONCLUSIONS HCQ-SAFE is a stakeholder-informed feasible shared decision-making tool that enhances communication and can potentially improve knowledge, clarify misbeliefs and engage patients in treatment decisions, including those with limited English proficiency.
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Affiliation(s)
- Shivani Garg
- Department of Medicine, Division of Rheumatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sancia Ferguson
- Department of Medicine, Division of Rheumatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Betty Chewning
- Department of Pharmacy, School of Pharmacy, Madison, Wisconsin, USA
| | - Shelby Gomez
- Department of Pharmacy, School of Pharmacy, Madison, Wisconsin, USA
| | | | - Christie Bartels
- Department of Medicine, Division of Rheumatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Abdelrahman W, Al-Shaarawy A, El-Zorkany B. Influence of perception of glucocorticoids on compliance of treatment in patients with rheumatoid arthritis and systemic lupus erythematosus. THE EGYPTIAN RHEUMATOLOGIST 2023. [DOI: 10.1016/j.ejr.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Garg S, Chewning B, Gazeley D, Gomez S, Kaitz N, Weber AC, Rosenthal A, Bartels C. Patient and healthcare team recommended medication adherence strategies for hydroxychloroquine: results of a qualitative study informing intervention development. Lupus Sci Med 2022; 9:9/1/e000720. [PMID: 35914839 PMCID: PMC9345084 DOI: 10.1136/lupus-2022-000720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/19/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Patients identified as black and from disadvantaged backgrounds have a twofold higher hydroxychloroquine (HCQ) non-adherence, which contributes to worse lupus outcomes and disparities. Yet, most adherence interventions lack tailored strategies for racially and socioeconomically diverse patients who face unique challenges with HCQ. We aimed to examine a broadly representative group of patients with SLE and physician perspectives on HCQ adherence and adherence strategies to redesign an adherence intervention. METHODS We conducted four virtual focus groups (90 min each) with 11 racially and socioeconomically diverse patients with SLE recruited from two health systems. Additionally, we hosted two focus group meetings with nine healthcare advisors. In focus groups, patients: (1) shared their perspectives on using HCQ; (2) shared concerns leading to non-adherence; (3) discussed strategies to overcome concerns; (4) prioritised strategies from the most to least valuable to inform an adherence intervention. In two separate focus groups, healthcare advisors gave feedback to optimise an adherence intervention. Using content analysis, we analysed transcripts to redesign our adherence intervention. RESULTS Worry about side effects was the most common barrier phrase mentioned by patients. Key themes among patients' concerns about HCQ included: information gaps, logistical barriers, misbeliefs and medication burden. Finally, patients suggested adherence strategies and ranked those most valuable including co-pay assistance, personal reminders, etc. Patient and healthcare advisors informed designing a laminate version of an adherence intervention to link each barrier category with four to six patient-recommended adherence strategies. CONCLUSION We developed a patient stakeholder-informed and healthcare stakeholder-informed tailored intervention that will target non-adherence at the individual patient level.
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Affiliation(s)
- Shivani Garg
- Department of Medicine, Division of Rheumatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Betty Chewning
- Department of Pharmacy, University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA
| | - David Gazeley
- Department of Medicine, Rheumatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shelby Gomez
- Department of Pharmacy, University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA
| | - Noah Kaitz
- Department of Pharmacy, University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, USA
| | - Amanda C Weber
- Department of Medicine, Division of Rheumatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ann Rosenthal
- Department of Medicine, Division of Rheumatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christie Bartels
- Department of Medicine, Division of Rheumatology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Emamikia S, Gentline C, Enman Y, Parodis I. How Can We Enhance Adherence to Medications in Patients with Systemic Lupus Erythematosus? Results from a Qualitative Study. J Clin Med 2022; 11:jcm11071857. [PMID: 35407466 PMCID: PMC8999748 DOI: 10.3390/jcm11071857] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022] Open
Abstract
Medication non-adherence is common among patients with systemic lupus erythematosus (SLE) and may lead to poor clinical outcomes. Our aim was to identify influenceable contributors to medication non-adherence and suggest interventions that could increase adherence. Patients with SLE from two Swedish tertiary referral centres (n = 205) participated in a survey assessing self-reported adherence to medications. Responses were used to select patients for qualitative interviews (n = 15). Verbatim interview transcripts were analysed by two researchers using content analysis methodology. The median age of the interviewees was 32 years, 87% were women, and their median SLE duration was nine years. Reasons for non-adherence were complex and multifaceted; we categorised them thematically into (i) patient-related (e.g., unintentional non-adherence due to forgetfulness or intentional non-adherence due to disbelief in medications); (ii) healthcare-related (e.g., untrustworthy relationship with the treating physician, authority fear, and poor information about the prescribed medications or the disease); (iii) medication-related (e.g., fear of side-effects); and (iv) disease-related reasons (e.g., lacking acceptance of a chronic illness or perceived disease quiescence). Interventions identified that healthcare could implement to improve patient adherence to medications included (i) increased communication between healthcare professionals and patients; (ii) patient education; (iii) accessible healthcare, preferably with the same personnel; (iv) well-coordinated transition from paediatric to adult care; (v) regularity in addressing adherence to medications; (vi) psychological support; and (vii) involvement of family members or people who are close to the patient.
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Affiliation(s)
- Sharzad Emamikia
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, 17176 Stockholm, Sweden; (C.G.); (Y.E.)
- Correspondence: (S.E.); (I.P.)
| | - Cidem Gentline
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, 17176 Stockholm, Sweden; (C.G.); (Y.E.)
| | - Yvonne Enman
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, 17176 Stockholm, Sweden; (C.G.); (Y.E.)
| | - Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, 17176 Stockholm, Sweden; (C.G.); (Y.E.)
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, 70182 Örebro, Sweden
- Correspondence: (S.E.); (I.P.)
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Brown R, Bateman CJ, Gossell-Williams M. Influence of Jamaican Cultural and Religious Beliefs on Adherence to Pharmacotherapy for Non-Communicable Diseases: A Pharmacovigilance Perspective. Front Pharmacol 2022; 13:858947. [PMID: 35359857 PMCID: PMC8963898 DOI: 10.3389/fphar.2022.858947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
Worldwide, socio-cultural determinants have been shown to influence the beliefs of patients about their health and decision making for treatment. This is consistent with the evidence that cultural and religious beliefs affect illness conceptualization and behaviors of Jamaican patients living with non-communicable diseases, such as diabetes mellitus and hypertension. Despite these known socio-cultural influences, an acknowledgment of relevance of adherence to pharmacotherapy has been grossly understudied. Furthermore, while poor adherence to pharmacotherapy, especially in the management of patients living with non-communicable diseases is associated with adverse drug reactions; reporting of such information in the pharmacovigilance process is inadequate. We review previous studies on the cultural and religious beliefs within the Jamaican context that may contribute to poor adherence to pharmacotherapy, especially among those patients living with non-communicable diseases. We support the ongoing perspective that current pharmacovigilance processes need retooling with the inclusion of socio-cultural influences on adherence to pharmacotherapy.
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Affiliation(s)
- Robyn Brown
- Department of Sociology, Psychology, and Social Work, Faculty of Social Sciences, The University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Caryl James Bateman
- Department of Sociology, Psychology, and Social Work, Faculty of Social Sciences, The University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Maxine Gossell-Williams
- Section of Pharmacology and Pharmacy, Faculty of Medical Sciences, The University of the West Indies, Mona Campus, Kingston, Jamaica
- *Correspondence: Maxine Gossell-Williams,
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Pirri S, Talarico R, Marinello D, Turchetti G, Mosca M. A systematic literature review of existing tools used to assess medication adherence in connective tissue diseases: the state of the art for the future development of co-designed measurement tools. Reumatismo 2021; 73. [PMID: 34814655 DOI: 10.4081/reumatismo.2021.1418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/18/2021] [Indexed: 11/23/2022] Open
Abstract
Lack of medication adherence is frequent in chronic connective tissue diseases and is associated with poorer health outcomes, low quality of life and economic loss. This research is based on a systematic literature search and aims to identify the surveys and tools used for the assessment of medication adherence in patients with connective tissue diseases (CTDs) and in particular the tools co-designed with patients. A systematic literature review was performed in PubMed and Embase databases searching for studies concerning the application of surveys or tools designed for medication adherence assessment. A specific analysis was also performed to identify which of these existing tools were developed in co-design with patients affected by CTDs. 1958 references were identified, and 31 studies were finally included. Systemic lupus erythematosus was the most investigated disease, followed by the Behçet's disease. The tools used to assess adherence in CTDs were, in most cases, valid and useful. However, the results showed a certain degree of heterogeneity among the studies and the medication adherence assessment and measurement tools adopted, which were mostly based on selfreported questionnaire. No co-designed tools with patients were found. Low- and non-adherence were explored in some CTDs with valid and useful tools, while other CTDs still need to be assessed. Therefore, more efforts should be made to better understand the specific reasons for the low- and non-adherence in CTDs patients.
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Affiliation(s)
- S Pirri
- Institute of Management, Scuola Superiore Sant'Anna, Pisa.
| | - R Talarico
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa.
| | - D Marinello
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa.
| | - G Turchetti
- Institute of Management, Scuola Superiore Sant'Anna, Pisa.
| | - M Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa.
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Sae-Lim O, Laobandit I, Kitchanwit P, Laichapis M, Siripaitoon B. Prevalence and associated factors of medication nonadherence among Thai patients with systemic lupus erythematosus. Lupus 2020; 30:352-359. [PMID: 33176565 DOI: 10.1177/0961203320973072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic disease requiring complex treatment strategies to prevent disease flare ups and to reduce hospitalizations. Medication adherence is the main concern for improving patient outcomes. Although various studies on medication nonadherence for SLE have been conducted, no definite conclusions have been reached. OBJECTIVE To quantify the prevalence of medication nonadherence among patients with SLE and to analyse the associated factors. METHODS A prospective, self-reported questionnaire study was conducted in Songklanagarind Hospital. Patient aged 18 years or older, who had an established diagnosis of SLE, and who had been receiving medications for at least 6 months, were included in the study. Medication adherence was assessed through a visual analogue scale (VAS) and through the medication-taking behaviour measure for Thai patients (MTB-Thai) scale. RESULTS One hundred and seventy-two SLE patients were enrolled in the study. Most SLE patients were young to middle aged (56.40%) and had no clinical disease activity (67.4%), as assessed by a clinical SLEDAI score. Nonadherence rates were 32% and 25.3% by VAS and the MTB-Thai scale, respectively. Patients aged 55 years or older, who used the universal coverage of health care system, who used multiple medications (>10 pills/day), and who had a good attitude towards the disease were associated with a low risk of nonadherence. CONCLUSION Up to 25% SLE patients poorly adhered to their prescriptions. Age, reimbursement scheme, pill number, and attitude towards SLE were associated with nonadherence in our patients with SLE.
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Affiliation(s)
- Orawan Sae-Lim
- Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Thailand
| | - Intouch Laobandit
- Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Thailand
| | - Punyawee Kitchanwit
- Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Thailand
| | - Manthana Laichapis
- Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Thailand
| | - Boonjing Siripaitoon
- Allergy and Rheumatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, HatYai, Thailand
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Sun K, Szymonifka J, Tian H, Chang Y, Leng JC, Mandl LA. Association of Traditional Chinese Medicine Use With Adherence to Prescribed Western Rheumatic Medications Among Chinese American Patients: A Cross-Sectional Survey. Arthritis Care Res (Hoboken) 2019; 72:1474-1480. [PMID: 31325227 DOI: 10.1002/acr.24031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 07/16/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Chinese Americans are a fast-growing immigrant group with worse rheumatic disease outcomes compared to white populations and frequently use traditional Chinese medicine (TCM). Whether TCM use is associated with lower adherence to Western rheumatic medications is unknown. The present study was undertaken to examine adherence to Western medications for systemic rheumatic diseases in the Chinese American immigrant population and its association with TCM use. METHODS Chinese Americans actively treated for a systemic rheumatic disease were recruited from 2 Chinatown clinics. Sociodemographic, TCM use, and clinical data were gathered. Self-reported health status was assessed using Patient-Reported Outcome Measurement Information System short forms. Adherence was stratified using the 8-item Morisky Medication Adherence Scale. Factors independently associated with high adherence were identified using multivariable logistic regression. RESULTS Of 230 subjects, the median age was 55 years (range 20-97 years), 65% were female, 71% had a high school education or less, 70% were enrolled in Medicaid, and 22% reported fluency in English. The most common rheumatic diagnoses were rheumatoid arthritis (41%), systemic lupus erythematosus (17%), and seronegative spondyloarthropathies (15%). One-half reported TCM use in the past year, and 28% reported high adherence to Western rheumatic medications. In multivariable analysis, high adherence was associated with TCM use (odds ratio [OR] 3.96, P < 0.001), being married (OR 3.69, P = 0.004), medication regimen complexity (OR 1.13, P = 0.004), and older age (OR 1.06, P < 0.001), and was negatively associated with anxiety (OR 0.94, P = 0.001). CONCLUSION While adherence to Western rheumatic medications was low in this cohort, interestingly, it was higher among TCM users compared to nonusers. TCM use appears to represent a complementary rather than an alternate approach to disease management for these patients. Future studies should evaluate whether TCM use is associated with better disease outcomes.
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Affiliation(s)
- Kai Sun
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Yaju Chang
- Mount Sinai Beth Israel Hospital, New York, New York
| | | | - Lisa A Mandl
- Hospital for Special Surgery, New York, New York
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11
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Corp N, Jordan JL, Croft PR. Justifications for using complementary and alternative medicine reported by persons with musculoskeletal conditions: A narrative literature synthesis. PLoS One 2018; 13:e0200879. [PMID: 30024952 PMCID: PMC6053199 DOI: 10.1371/journal.pone.0200879] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 05/28/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Complementary and alternative medicine (CAM) is very popular with patients frequently combining it with orthodox health care. The high prevalence of CAM use and satisfaction with CAM reported by patients directly challenges an orthodox system that can only approve such use if it results from the application of biomedical concepts and science. Studies highlighting this as a cultural, sociological and historical phenomenon emphasise the value of choice for consumers of health care. Musculoskeletal conditions typify common problems for which the effectiveness of orthodox care is often unclear. We postulated that the reasons people give for using or not using CAM for musculoskeletal conditions, would therefore indicate the full range of expectations that people have of health care. Furthermore, these reasons would indicate how much people feel orthodox health care is or is not meeting their expectations. Therefore, this study aims to investigate people's reasons for choosing or avoiding CAM for non-traumatic musculoskeletal conditions. METHODS A systematic search and narrative synthesis was conducted of published qualitative and quantitative studies related to CAM and non-traumatic musculoskeletal conditions. RESULTS We identified 169 relevant papers detailing 152 separate studies, from which 1486 justifications were extracted concerning CAM use. Content analysis resulted in 11 distinct categories across four themes: practical aspects of care, clinical effectiveness, non-clinical outcomes of care, and a person's philosophy of illness and care. People provided similar rationales for both using and avoiding CAM, emphasising that, whilst CAM is perceived by many patients with musculoskeletal conditions to fill gaps in care (such as practitioner time or quality of the therapeutic relationship), orthodox care also seeks to deliver these aspects of care. However, people who used CAM also highlighted its alignment with their general philosophy and ideas about illness and health care, and often emphasised CAM's capacity to give them control over their condition and its treatment. CONCLUSION Currently, CAM appears to have a significant role for patients with common painful long-term conditions in providing choices to enable individual needs to be met.
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Affiliation(s)
- Nadia Corp
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
| | - Joanne L. Jordan
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
| | - Peter R. Croft
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
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Haag H, Liang T, Avina-Zubieta JA, De Vera MA. How do patients with systemic autoimmune rheumatic disease perceive the use of their medications: a systematic review and thematic synthesis of qualitative research. BMC Rheumatol 2018; 2:9. [PMID: 30886960 PMCID: PMC6390776 DOI: 10.1186/s41927-018-0017-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/15/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Hans Haag
- 1University of British Columbia, Faculty of Pharmaceutical Sciences, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada.,Arthritis Research Canada, Richmond, BC Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC Canada
| | - Tim Liang
- 1University of British Columbia, Faculty of Pharmaceutical Sciences, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada.,Arthritis Research Canada, Richmond, BC Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC Canada
| | - J Antonio Avina-Zubieta
- Arthritis Research Canada, Richmond, BC Canada.,4Department of Medicine, Division of Rheumatology, University of British Columbia, Faculty of Medicine, Vancouver, BC Canada
| | - Mary A De Vera
- 1University of British Columbia, Faculty of Pharmaceutical Sciences, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada.,Arthritis Research Canada, Richmond, BC Canada.,Collaboration for Outcomes Research and Evaluation, Vancouver, BC Canada
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13
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The Effect of Psychosocial and Neuropsychiatric Factors on Medication Adherence in a Cohort of Women With Systemic Lupus Erythematosus. J Clin Rheumatol 2018; 22:411-417. [PMID: 27870763 DOI: 10.1097/rhu.0000000000000470] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Medication adherence in systemic lupus erythematosus (SLE) reduces disease activity and the risk of flares. OBJECTIVES We evaluated adherence in women with SLE who exhibit high morbidity and mortality. We evaluated demographic data and 2 conventional adherence predictors: self-efficacy and health literacy, along with 2 potential neuropsychiatric SLE complications: cognitive dysfunction and depression. METHODS One hundred six women randomly selected from the Barbados National Lupus Registry completed the Self-efficacy for Appropriate Medication Use Scale, Rapid Estimate of Adult Literacy in Medicine-Short Form, Cognitive Symptom Inventory, Beck Depression Inventory II, and Morisky's Medication Adherence Questionnaire (MAQ). This study explored the effects of psychosocial and neuropsychiatric functioning on adherence using ordinal logistic regression. RESULTS Sixty percent reported high MAQ scores. The probability of high MAQ scores was lower among younger patients (P = 0.001) and those with shorter disease duration (P = 0.05). The probability of high MAQ scores fell with lower perceived self-efficacy (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.73-0.89; P < 0.001), worsening cognitive function (OR, 0.90; 95% CI, 0.84-0.97; P = 0.004), and increasing depression (OR, 0.93; 95% CI, 0.88-0.97; P = 0.002). There was no strong relationship between MAQ score and health literacy (OR, 0.37; 95% CI, 0.13-1.03; P = 0.06). CONCLUSION Women with SLE who are younger and those with shorter disease duration should be assessed for medication adherence. Screening at diagnosis followed by routine assessment of cognitive dysfunction and depression along with perceived self-efficacy may further identify the most vulnerable subgroup who should be targeted with personalized intervention strategies.
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14
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Xie X, Yang H, Nie A, Chen H, Li J. Predictors of medication nonadherence in patients with systemic lupus erythematosus in Sichuan: a cross-sectional study. Patient Prefer Adherence 2018; 12:1505-1511. [PMID: 30197502 PMCID: PMC6112788 DOI: 10.2147/ppa.s169776] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The aim of this study was to determine the prevalence and predictors of medication nonadherence among patients with systemic lupus erythematosus (SLE) in Sichuan. PATIENTS AND METHODS A cross-sectional investigation was performed. Participants were recruited by consecutive sampling from the Rheumatic Clinic of a university hospital between June and September 2016. Patients' self-reported medication adherence was assessed by the eight-item Morisky Medication Adherence Scale. Additional surveys included patients' demographics, and clinical and treatment characteristics. Logistic regression analysis was used to identify the predictors of medication nonadherence. RESULTS A total of 140 patients were included in analysis. The percentage of patients classified as nonadherent to medication was 75%. Low education, rural residency, childlessness, limited comprehension of medication instructions, side effects experienced, dissatisfaction with treatment and better physical health were associated with an increased risk of nonadherence. CONCLUSION This study demonstrated a high prevalence of medication nonadherence among SLE patients in Sichuan, and factors associated with the nonadherence are multifaceted. Interventions for these factors, such as appropriate adjustment of the service resources for patients with rheumatic disease in rural communities and improved communication between the health care providers and the patients, may contribute to improve the medication adherence of this cohort.
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Affiliation(s)
- Xia Xie
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
| | - Hui Yang
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
| | - Anliu Nie
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
| | - Hong Chen
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
| | - Jiping Li
- West China School of Nursing and Department of Nursing, West China Hospital, Sichuan University, Chengdu, China,
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Prados-Moreno S, Sabio JM, Pérez-Mármol JM, Navarrete-Navarrete N, Peralta-Ramírez MI. Adherencia al tratamiento en pacientes con lupus eritematoso sistémico. Med Clin (Barc) 2018; 150:8-15. [DOI: 10.1016/j.medcli.2017.05.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/12/2017] [Accepted: 05/18/2017] [Indexed: 01/30/2023]
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The Influence of Income and Formal Education on Damage in Brazilian Patients With Systemic Lupus Erythematosus. J Clin Rheumatol 2017; 23:246-251. [DOI: 10.1097/rhu.0000000000000541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Maloney KC, Ferguson TS, Stewart HD, Myers AA, De Ceulaer K. Clinical and immunological characteristics of 150 systemic lupus erythematosus patients in Jamaica: a comparative analysis. Lupus 2017; 26:1448-1456. [PMID: 28480787 DOI: 10.1177/0961203317707828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Epidemiological studies in systemic lupus erythematosus have been reported in the literature in many countries and ethnic groups. Although systemic lupus erythematosus in Jamaica has been described in the past, there has not been a detailed evaluation of systemic lupus erythematosus patients in urban Jamaica, a largely Afro-Caribbean population. The goal of this study was to describe the clinical features, particularly disease activity, damage index and immunological features, of 150 systemic lupus erythematosus subjects. Methods 150 adult patients (≥18 years) followed in rheumatology clinic at a tertiary rheumatology hospital centre (one of two of the major public referral centres in Jamaica) and the private rheumatology offices in urban Jamaica who fulfilled Systemic Lupus International Collaborating Clinics (SLICC) criteria were included. Data were collected by detailed clinical interview and examination and laboratory investigations. Hence demographics, SLICC criteria, immunological profile, systemic lupus erythematosus disease activity index 2000 (SLEDAI-2K) and SLICC/American College of Rheumatology (ACR) damage index (SDI) were documented. Results Of the 150 patients, 145 (96.7%) were female and five (3.3%) were male. The mean age at systemic lupus erythematosus onset was 33.2 ± 10.9. Mean disease duration was 11.3 ± 8.6 years. The most prevalent clinical SLICC criteria were musculoskeletal, with 141 (94%) of subjects experiencing arthralgia/arthritis, followed by mucocutaneous manifestations of alopecia 103 (68.7%) and malar rash 46 (30.7%), discoid rash 45 (30%) and photosensitivity 40 (26.7%). Lupus nephritis (biopsy proven) occurred in 42 (28%) subjects and 25 (16.7%) met SLICC diagnostic criteria with only positive antinuclear antibodies/dsDNA antibodies and lupus nephritis on renal biopsy. The most common laboratory SLICC criteria were positive antinuclear antibodies 136 (90.7%) followed by anti-dsDNA antibodies 95 (63.3%) and low complement (C3) levels 38 (25.3%). Twenty-seven (18%) met SLICC diagnostic criteria with only positive antinuclear antibodies/anti-dsDNA antibodies and lupus nephritis on renal biopsy. Mean SLEDAI score was 6.9 ± 5.1 with a range of 0–32. Organ damage occurred in 129 (86%) patients; mean SDI was 2.4 ± 1.8, with a range of 0–9. Conclusion These results are similar to the clinical manifestations reported in other Afro-Caribbean populations; however, distinct differences exist with respect to organ involvement and damage, particularly with respect to renal involvement, which appears to be reduced in our participants.
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Affiliation(s)
- K C Maloney
- Department of Medicine, University of the West Indies, Mona, Jamaica
| | - T S Ferguson
- Epidemiology Research Unit, Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - H D Stewart
- Department of Medicine, University of the West Indies, Mona, Jamaica
| | - A A Myers
- Department of Medicine, University of the West Indies, Mona, Jamaica
| | - K De Ceulaer
- Department of Medicine, University of the West Indies, Mona, Jamaica
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Farinha F, Freitas F, Águeda A, Cunha I, Barcelos A. Concerns of patients with systemic lupus erythematosus and adherence to therapy - a qualitative study. Patient Prefer Adherence 2017; 11:1213-1219. [PMID: 28761334 PMCID: PMC5522825 DOI: 10.2147/ppa.s137544] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The objectives of this study were 1) to identify the impact of systemic lupus erythematosus (SLE) on patients' lives and their reactions to this, as well as their main concerns and expectations regarding their disease and treatments; and 2) to assess the relationship between these concerns and the adherence to treatments, medical visits, and diagnostic tests. PATIENTS AND METHODS Qualitative study, using a convenient sample of SLE patients attending an outpatient rheumatology clinic. Semistructured interviews were conducted and audiotaped. The full transcripts were analyzed by two different coders using content analysis methodology. RESULTS Fifteen participants were included. SLE had a major impact on these patients' lives. Their main concerns were fear of disease worsening and becoming dependent on other people, fear of not being able to take care of their children or provide for the family, and the possibility of transmitting SLE to their offspring. The main reasons for adherence to therapy were the wish to avoid manifestations of SLE and trust in the rheumatologist and routine. Nonadherence was more common in the beginning of the treatment because of the difficulty in accepting a chronic disease that requires lifelong therapy. CONCLUSION Our data underlined the important interplay between adherence to medication and the possibility to gather accurate information and proper support during the treatment process. Good communication and efficient patient education strategies, focused on improving their knowledge about the disease and its treatments, may be important to improve adherence to therapy in SLE.
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Affiliation(s)
- Filipa Farinha
- Rheumatology Department, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal
- Correspondence: Filipa Farinha, Serviço de Reumatologia – Centro Hospitalar do Baixo Vouga, Av. Artur Ravara, 3810–501 Aveiro, Portugal, Tel +351 234 378 300, Fax +351 234 378 395, Email
| | - Francisco Freitas
- Centre for Social Studies, Universidade de Coimbra, Coimbra, Portugal
| | - Ana Águeda
- Rheumatology Department, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal
| | - Inês Cunha
- Rheumatology Department, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal
| | - Anabela Barcelos
- Rheumatology Department, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal
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Feldman CH, Yazdany J, Guan H, Solomon DH, Costenbader KH. Medication Nonadherence Is Associated With Increased Subsequent Acute Care Utilization Among Medicaid Beneficiaries With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2016; 67:1712-21. [PMID: 26097166 DOI: 10.1002/acr.22636] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 04/30/2015] [Accepted: 06/02/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We examined whether nonadherence to hydroxychloroquine (HCQ) or immunosuppressive medications (ISMs) was associated with higher subsequent acute care utilization among Medicaid beneficiaries with systemic lupus erythematosus (SLE). METHODS We utilized US Medicaid data from 2000-2006 to identify adults ages 18-64 years with SLE who were new users of HCQ or ISMs. We defined the index date as receipt of HCQ or ISMs without use in the prior 6 months. We measured adherence using the medication possession ratio (MPR), the proportion of days covered by total days' supply dispensed, for the 1-year post-index date. Our outcomes were all-cause and SLE-related emergency department (ED) visits and hospitalizations in the subsequent year. We used multivariable Poisson regression models to examine the association between nonadherence (MPR <80%) and acute care utilization, adjusting for sociodemographics and comorbidities. RESULTS We identified 9,600 HCQ new users and 3,829 ISM new users with SLE. The mean ± SD MPR for HCQ was 47.8% ± 30.3% and for ISMs was 42.7% ± 30.7%. Seventy-nine percent of HCQ users and 83% of ISM users were nonadherent (MPR <80%). In multivariable models, among HCQ users, the incidence rate ratio (IRR) of ED visits was 1.55 (95% confidence interval [95% CI] 1.43-1.69) and the IRR of hospitalizations was 1.37 (95% CI 1.25-1.50), comparing nonadherers to adherers. For ISM users, the IRR of ED visits was 1.64 (95% CI 1.42-1.89) and of hospitalizations was 1.67 (95% CI 1.41-1.96) for nonadherers versus adherers. CONCLUSION In this cohort, nonadherence to HCQ and ISMs was common and was associated with significantly higher subsequent acute care utilization.
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Affiliation(s)
| | | | - Hongshu Guan
- Brigham and Women's Hospital, Boston, Massachusetts
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Oliveira-Santos M, Verani JFDS, Camacho LAB, de Andrade CAF, Ferrante-Silva R, Klumb EM. Effectiveness of pharmaceutical care for drug treatment adherence in patients with systemic lupus erythematosus in Rio de Janeiro, Brazil: study protocol for a randomized controlled trial. Trials 2016; 17:181. [PMID: 27038611 PMCID: PMC4818901 DOI: 10.1186/s13063-016-1317-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/30/2016] [Indexed: 12/02/2022] Open
Abstract
Background Treatment adherence is a primary determinant of the success and effectiveness of healthcare. Lack of adherence can lead to treatment failure and death. Although studies have shown that pharmaceutical intervention can improve drug treatment for patients with chronic diseases, studies on pharmaceutical care are not only inconsistent, they are scarce and limited to developed countries, include few patients, and are not studied in randomized clinical trials. Systemic lupus erythematosus is an autoimmune disease with high hospitalization and case-fatality rates. The adherence rate is low (31.7 %) in this group of patients in Brazil, and drug treatment for the disease is complex. Our objective is to evaluate the effectiveness of pharmaceutical care in drug treatment adherence in patients with systemic lupus erythematosus treated at a rheumatology outpatient clinic in Rio de Janeiro, Brazil. Methods A randomized clinical trial (pragmatic trial) will be conducted. Adult participants (women) from a public hospital in Rio de Janeiro with a diagnosis of systemic lupus erythematosus will be followed for 12 months. A total of 120 patients will be randomized to two groups: intervention (Dader method for pharmaceutical care) and control (health/dietary counseling and risk reduction). The primary outcome will be drug treatment adherence evaluated by the eight-item Morisky Medication Adherence Scale. Secondary outcomes will be clinical improvement and quality of life. Discussion Patients with systemic lupus erythematosus present with low treatment adherence, thus justifying the mobilization of human resources to optimize their clinical management. Despite the proven effectiveness of pharmaceutical care for various diseases, there are still no studies evaluating its effectiveness in systemic lupus erythematosus. Our hypothesis is that the intervention will also be effective in this patient group. Trial registration ClinicalTrials.gov identifier: NCT02330250. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1317-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marise Oliveira-Santos
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro, Brazil. .,Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro n° 77, Vila Isabel, Rio de Janeiro, Brazil.
| | - José Fernando de Souza Verani
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro, Brazil
| | - Luiz Antônio Bastos Camacho
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro, Brazil
| | - Carlos Augusto Ferreira de Andrade
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil n° 4.036, Manguinhos, Rio de Janeiro, Brazil.,Severino Sombra University, Av. Expedicionário Oswaldo de Almeida Ramos, n° 280, Centro, Vassouras, Rio de Janeiro, Brazil
| | - Rosele Ferrante-Silva
- Lagoa Federal Hospital, Ministry of Health, Rua Jardim Botânico n° 501, Jardim Botânico, Rio de Janeiro, Brazil
| | - Evandro Mendes Klumb
- Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro n° 77, Vila Isabel, Rio de Janeiro, Brazil
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Elfving P, Puolakka K, Kautiainen H, Virta LJ, Pohjolainen T, Kaipiainen-Seppänen O. Drugs used in incident systemic lupus erythematosus – results from the Finnish nationwide register 2000–2007. Lupus 2016; 25:666-70. [DOI: 10.1177/0961203316628998] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/30/2015] [Indexed: 11/16/2022]
Abstract
The objectives of the study were to examine the initial, first-year anti-rheumatic outpatient therapy in patients with incident SLE, as well as the concomitant use of drugs for certain comorbidities, compared to the use in the general population. The Finnish nationwide register data on special reimbursements for medication costs was screened to identify the inception cohort of 566 adult SLE patients (87% females, mean age 46.5 ± 15.9 years) over the years 2000–2007. The patients were linked to the national Drug Purchase Register. Of those, 90% had purchased at least once some disease-modifying anti-rheumatic drugs (DMARDs) during the first year. Hydroxychloroquine was the most common (76%), followed by azathioprine (15%) and methotrexate (13%). With the exception of increase in mycophenolate mofetil, the proportions remained stable over the whole study period 2000–2007. Drugs for cardiovascular diseases, dyslipidemia, diabetes mellitus, hypothyroidism and obstructive pulmonary disease were more frequently purchased than in the sex- and age-adjusted population, with rate ratios ranging from 1.6 to 7.8. Over the years 2000–2007, almost all the patients with incident SLE in Finland started with a DMARD. Higher percentages of SLE patients were on medication for several common chronic diseases than in the population as a whole.
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Affiliation(s)
- P Elfving
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - K Puolakka
- Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland
| | - H Kautiainen
- Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
- Department of General Practice, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - L J Virta
- Research Department, Social Insurance Institution, Turku, Finland
| | - T Pohjolainen
- Rehabilitation Unit, Orton Hospital, Helsinki, Finland
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Affiliation(s)
- G R V Hughes
- London Lupus Centre, London Bridge Hospital, Tooley Street, London, UK
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23
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Adherence to Oral and Topical Medications in Cutaneous Lupus Erythematosus is not Well Characterized. Dermatol Ther (Heidelb) 2015; 5:91-105. [PMID: 25899142 PMCID: PMC4470959 DOI: 10.1007/s13555-015-0075-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Treatment adherence plays a large role in chronic dermatologic diseases and may play an important role in the outcomes of patients with cutaneous lupus erythematosus (CLE). We sought to gauge what is currently known about adherence to topical and oral medications in patients with CLE. METHODS A review of MEDLINE was performed using a combination of the phrases "adherence", "compliance", "lupus", and "cutaneous". Studies were hand searched and prospective and cross-sectional studies evaluating medication adherence in patients with CLE and systemic lupus erythematosus (SLE) were included. RESULTS Only two articles explored adherence in patients with CLE, while 17 articles discussed treatment adherence in patients with SLE. Depression was consistently cited as detrimental to adherence. The impact that race, ethnicity, and education has on adherence is unclear. Three studies noted a clear connection between adherence and disease activity, while two others did not. Few studies investigated methods that have improved adherence to treatment which have showed promise. CONCLUSION Much of what we know about adherence to medication in patients with lupus is limited to SLE. Although cutaneous symptoms are among the most common manifestations of SLE, cutaneous disease is often managed at least in part with topical agents, and adherence to topical treatment was not assessed in any of the articles, though one study investigated sunscreen usage in patients with CLE. Understanding adherence in patients with CLE may help contribute to better CLE treatment outcomes.
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Beckerman NL, Auerbach C, Kim SJ, Salmon J, Horton R. Lupus (SLE): Existence and Impact of Depressive Symptomatology. SOCIAL WORK IN HEALTH CARE 2015; 54:499-517. [PMID: 26186422 DOI: 10.1080/00981389.2015.1045575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this cross-sectional study (N = 84) is to: (1) further identify the unique psychosocial challenges facing those living with Systemic Lupus Erythematosus (SLE) and (2) discern the validity of the depression dimension of the System Lupus Erythematosus Needs Questionnaire (SLENQ) (by including the Beck Depression Inventory [BDI-II]). Utilizing the BDI-II, this study replicates and confirms the validity of studies that employed the SLENQ, establishing that those who have manifested signs of depression in the SLENQ, are equally likely to show signs of depression in the BDI-II. Authors identify and confirm that patients who experience SLE-related depression are significantly more likely to forget taking or stop taking their SLE medications. The authors review relevant research, discuss findings, and provide evidence-based recommendations for social workers providing mental health care to patients living with Lupus.
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Alves VLP, Carniel AQ, Costallat LTL, Turato ER. Meanings of the sickening process for patients with systemic lupus erythematosus: a review of the literature. REVISTA BRASILEIRA DE REUMATOLOGIA 2014; 55:522-7. [PMID: 25440711 DOI: 10.1016/j.rbr.2014.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 07/12/2014] [Accepted: 08/26/2014] [Indexed: 12/22/2022] Open
Abstract
Systemic lupus erythematosus is an autoimmune disease that causes many psychological repercussions that have been studied through qualitative research. These are considered relevant, since they reveal the amplitude experienced by patients. Given this importance, this study aims to map the qualitative production in this theme, derived from studies of experiences of adult patients of both genders and that had used as a tool a semi-structured interview and/or field observations, and had made use of a sampling by a saturation criterion to determine the number of participants in each study. The survey was conducted in Pubmed, Lilacs, Psycinfo e Cochrane databases, searching productions in English and Portuguese idioms published between January 2005 and June 2012. The 19 revised papers that have dealt with patients in the acute phase of the disease showed themes that were categorized into eight topics that contemplated the experienced process at various stages, from the onset of the disease, extending through the knowledge of the diagnosis and the understanding of the manifestations of the disease, drug treatment and general care, evolution and prognosis. The collected papers also point to the difficulty of understanding, of the patients, on what consists the remission phase, revealing also that this is a clinical stage underexplored by psychological studies.
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Tazi Mezalek Z, Bono W. Challenges for lupus management in emerging countries. Presse Med 2014; 43:e209-20. [PMID: 24857588 DOI: 10.1016/j.lpm.2014.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 12/23/2022] Open
Abstract
In emerging countries, systemic lupus erythematosus (SLE) has been associated with several unfavorable outcomes including disease activity, damage accrual, work disability and mortality. Poor socioeconomic status (SES) and lack of access to healthcare, especially in medically underserved communities, may be responsible for many of the observed disparities. Diagnostic delay of SLE or for severe organ damages (renal involvement) have a negative impact on those adverse outcomes in lupus patients who either belong to minority groups or live in emerging countries. Longitudinal and observational prospective studies and registries may help to identify the factors that influence poor SLE outcomes in emerging countries. Infection is an important cause of mortality and morbidity in SLE, particularly in low SES patients and tuberculosis appears to be frequent in SLE patients living in endemic areas (mainly emerging countries). Thus, tuberculosis screening should be systematically performed and prophylaxis discussed for patients from these areas. SLE treatment in the developing world is restricted by the availability and cost of some immunosuppressive drugs. Moreover, poor adherence has been associated to bad outcomes in lupus patients with a higher risk of flares, morbidity, hospitalization, and poor renal prognosis. Low education and the lack of money are identified as the main barrier to improve lupus prognosis. Newer therapeutic agents and new protocols had contributed to improve survival in SLE. The use of corticoid-sparing agents (hydroxychloroquine, methotrexate, azathioprine and mycophenolate mofetif) is one of the most useful strategy; availability of inexpensive generics may help to optimize access to these medications.
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Affiliation(s)
- Zoubida Tazi Mezalek
- Université Mohamed V Souissi, Faculté de médecine et de pharmacie, 10000 Rabat, Morocco; Ibn Sina University Hospital, internal medicine department, 10000 Rabat, Morocco.
| | - Wafaa Bono
- Hassan II University Hospital, internal medicine and immunology Clinic, Fès, Morocco
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Gross R, Graybill J, Wahezi D, Jordan NC, Putterman C, Blanco I. Increased Education is Associated with Decreased Compliance in an Urban Multi-Ethnic Lupus Cohort. ACTA ACUST UNITED AC 2014; 5. [PMID: 25419480 PMCID: PMC4240278 DOI: 10.4172/2155-9899.1000215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To investigate the factors associated with medication compliance in a multi-ethnic population of patients with systemic lupus erythematosus in an urban community. METHODS We surveyed patients in our cohort using the standardized measures of the Compliance-Questionnaire-Rheumatology (CQR), the Beliefs about Medications Questionnaire (BMQ), as well as patient self-reported compliance. Demographic and clinical characteristics of compliant and non-compliant patients underwent bivariate analysis. A multivariate analysis was then performed on variables of interest. RESULTS Of the 94 patients who agreed to participate in the survey, 89 fully completed each questionnaire. Overall, 48% of patients were compliant by CQR. In multivariate analyses, higher education level was associated with non-compliance. Spanish-speaking patients and those with an income of greater than $15,000 per year were more likely to be compliant. CONCLUSIONS In this urban lupus population, several factors may influence medication compliance. Factors associated with non-compliance are not what have been found in other populations. Further studies looking into specific reasons for certain areas of non-compliance as well as addressing these issues will be important in both treatment and outcomes in lupus patients in implementing appropriate interventions.
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Affiliation(s)
- Rachel Gross
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jennifer Graybill
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dawn Wahezi
- Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nicole C Jordan
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Chaim Putterman
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Irene Blanco
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, NY, USA
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Sutanto B, Singh-Grewal D, McNeil HP, O'Neill S, Craig JC, Jones J, Tong A. Experiences and Perspectives of Adults Living With Systemic Lupus Erythematosus: Thematic Synthesis of Qualitative Studies. Arthritis Care Res (Hoboken) 2013; 65:1752-65. [DOI: 10.1002/acr.22032] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/03/2013] [Accepted: 04/10/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Bernadet Sutanto
- University of Sydney and The Children's Hospital at Westmead; Sydney, New South Wales Australia
| | - Davinder Singh-Grewal
- University of Sydney, The Children's Hospital at Westmead, University of New South Wales, and Liverpool Hospital; Sydney, New South Wales Australia
| | - H. Patrick McNeil
- University of New South Wales and Liverpool Hospital; Sydney, New South Wales Australia
| | - Sean O'Neill
- University of New South Wales and Liverpool Hospital; Sydney, New South Wales Australia
| | - Jonathan C. Craig
- University of Sydney and The Children's Hospital at Westmead; Sydney, New South Wales Australia
| | - Julie Jones
- University of Sydney; Sydney, New South Wales Australia
| | - Allison Tong
- University of Sydney and The Children's Hospital at Westmead; Sydney, New South Wales Australia
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Marengo MF, Waimann CA, Achaval SD, Zhang H, Garcia-Gonzalez A, Richardson MN, Reveille JD, Suarez-Almazor ME. Measuring therapeutic adherence in systemic lupus erythematosus with electronic monitoring. Lupus 2012; 21:1158-65. [DOI: 10.1177/0961203312447868] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: We used an electronic monitoring system to quantify adherence to prescribed oral therapies by patients with systemic lupus erythematosus (SLE). Methods: Participants were included from a larger longitudinal study cohort of 110 patients recruited from publicly-funded rheumatology clinics, 78 of whom agreed to have their SLE drug therapy electronically monitored for two years with the Medication Events Monitoring System (MEMS®, AARDEX Group). Adherence was determined as the percentage of days (weeks for methotrexate) the patient took the medication as prescribed by the physician. Collected data included SLEDAI; SLICC damage index for SLE (SDI); medical outcome study social support survey (MOS-SSS); Center for Epidemiologic Studies depression scale (CESD); and quality of life (SF-12). Results: Ninety percent of the cohort was female, 45% were Hispanic, and 49% were African-American. Mean age was 36.3 years, disease duration was 5.9 years, SLEDAI score was 3.2, and SDI score was 0.9. Adherence was 62% for all drugs combined and did not differ significantly for individual medications. Patients with more depression ( p < 0.02), and higher number of pills taken daily ( p < 0.02) were more likely to be non-adherent. Only one-fourth of the patients had an average adherence of ≥80%; these patients had a better mental component score (SF-12) at 24 months than non-adherent patients ( p < 0.01). Conclusions: Electronic monitoring demonstrated that only one-fourth of the patients had an adherence rate ≥80%. Polypharmacy and depression were associated with non-adherence.
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Affiliation(s)
- MF Marengo
- The University of Texas MD Anderson Cancer Center, USA
| | - CA Waimann
- The University of Texas MD Anderson Cancer Center, USA
| | - S de Achaval
- The University of Texas MD Anderson Cancer Center, USA
| | - H Zhang
- The University of Texas MD Anderson Cancer Center, USA
| | | | - MN Richardson
- The University of Texas MD Anderson Cancer Center, USA
| | - JD Reveille
- The University of Texas Medical School at Houston, USA
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Zerah L, Arena C, Morin AS, Blanchon T, Cabane J, Fardet L. [Patients' beliefs about long-term glucocorticoid therapy and their association to treatment adherence]. Rev Med Interne 2012; 33:300-4. [PMID: 22444116 DOI: 10.1016/j.revmed.2012.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 01/26/2012] [Accepted: 02/12/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND In patients treated with systemic glucocorticoids (GCs), it is unknown if beliefs about the treatment are associated with level of reported adherence. PATIENTS AND METHODS Cross-sectional study conducted in two departments of internal medicine during a six-month period. All patients receiving long-term GCs therapy were asked to fill in a questionnaire regarding their beliefs about (specific scale of the Beliefs about Medicines Questionnaire) and their adherence to (four-item Morisky-Green scale) GCs. Logistic regression analysis was used to assess association between beliefs about GCs and adherence to treatment. RESULTS One hundred and eighty one questionnaires were analysed (women: 79%, median age [IQR]: 47 [33-61] years, median duration of treatment: 18 [7-72] months, median daily dosage of prednisone equivalent: 10 [6-20] mg). Among these 181 patients, 83 (46%) reported a "concern" score equal to or higher than the "necessity" score. Nineteen percent of patients reported a low adherence level. In multivariate analysis, these patients were significantly younger (OR: 0.96 [0.93-0.98] per increasing year of age, P=0.002) and reported more frequently a "concern" score higher than a "necessity" score (OR: 3.08 [1.27-7.46], P=0.01) as compared to patients reporting a high adherence level. CONCLUSION Informing patients about the "necessity" of GCs and taking into account their "concerns" about adverse events or their fear of becoming dependent on the medication may improve their adherence to treatment.
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Affiliation(s)
- L Zerah
- Service de médecine interne, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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Yilmaz O, Eroglu N, Ozalp D, Yuksel H. Beliefs about medications in asthmatic children presenting to emergency department and their parents. J Asthma 2012; 49:282-7. [PMID: 22303961 DOI: 10.3109/02770903.2011.654021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of our study was to assess the relationship of beliefs about medications questionnaire (BMQ) scores of asthmatic children presenting to the emergency department and their parents with asthma severity parameters. METHODS Eighty children with asthma presenting to the emergency department with acute asthma findings and their mothers were enrolled in the study. BMQ was applied to all parents and children older than 7 years of age. Asthma severity clinical score was recorded. RESULTS The mean age of children (39 males, 41 females) was 49.1 ± 42.8 months. Parent necessity and concerns scores were significantly correlated with their counterparts in children (r = 0.74 and r = 0.60, respectively). Difference between necessity and concerns scores was correlated between parents and children (r = 0.60, p = .002). Child's necessity score was significantly correlated with respiratory severity score (r = -0.43, p = .036). CONCLUSION BMQ necessity and concerns scores of asthmatic children in the emergency department and their parents are correlated with asthma severity. Although not assessed in this study, this result may be attributed to the relationship of necessity and concerns with drug adherence. Therefore, increasing the knowledge about asthma medications in asthmatic children and their parents may contribute to asthma control and decrease their emergency visits with acute asthma findings.
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Affiliation(s)
- Ozge Yilmaz
- Department of Pediatric Allergy and Pulmonology, Celal Bayar University Medical Faculty, Celal Bayar University, Manisa, Turkey.
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Hui-Yuen JS, Imundo LF, Avitabile C, Kahn PJ, Eichenfield AH, Levy DM. Early versus later onset childhood-onset systemic lupus erythematosus: Clinical features, treatment and outcome. Lupus 2011; 20:952-9. [DOI: 10.1177/0961203311403022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The objective of the study was to compare clinical features, treatment and disease outcome in patients with early versus later onset of childhood-onset systemic lupus erythematosus (cSLE). A retrospective matched cohort study of cSLE patients diagnosed between 1988 and 2008 and followed for a minimum of one year was conducted. Thirty-four pre-pubertal cSLE patients with disease onset prior to their 12th birthday were matched by ethnicity and year of diagnosis to 34 pubertal cSLE patients. The most common criteria at diagnosis in both groups were malar rash, arthritis, hematologic manifestations, and renal disease. After a mean follow-up of more than six years, a similar proportion of patients in the two groups were still prescribed corticosteroids (47% and 41%); patients in the early onset group required a significantly higher daily dose (0.6 mg/kg prednisone-equivalent versus 0.2 mg/kg, p < 0.05). There were no significant differences in organ involvement, disease activity and disease damage between the two groups, and severe complications occurred at similar rates. There were a greater number of admissions to the pediatric intensive care unit (PICU) in the early onset group (18 versus 5, p = 0.01), with time-to-event analysis demonstrating a significantly shorter disease duration from diagnosis to first PICU admission in the early onset group ( p < 0.001). While a similar proportion of patients in the early and later onset groups required treatment with cyclophosphamide, patients in the early onset group received treatment earlier in their disease course (mean 13.7 versus 19.9 months, p < 0.001). Early onset cSLE leads to earlier and more frequent PICU admission, earlier use of cyclophosphamide, and higher corticosteroid dose at long-term follow-up.
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Affiliation(s)
- JS Hui-Yuen
- Department of Pediatrics, Stonybrook University, USA
| | - LF Imundo
- Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York Presbyterian, Columbia University Medical Center, New York, USA
| | - C Avitabile
- Pediatric Cardiology, Children’s Hospital of Philadelphia, Philadelphia, USA
| | - PJ Kahn
- Pediatric Rheumatology, New York University, New York, USA
| | - AH Eichenfield
- Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York Presbyterian, Columbia University Medical Center, New York, USA
| | - DM Levy
- Paediatric Rheumatology, Hospital for Sick Children and University of Toronto, Toronto, Canada
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Kumar K, Gordon C, Barry R, Shaw K, Horne R, Raza K. 'It's like taking poison to kill poison but I have to get better': a qualitative study of beliefs about medicines in Rheumatoid arthritis and Systemic lupus erythematosus patients of South Asian origin. Lupus 2011; 20:837-44. [PMID: 21511761 DOI: 10.1177/0961203311398512] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate factors that influence beliefs about medicines in patients of South Asian origin with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). METHODS Qualitative methodology was used to explore the health beliefs of South Asian patients and in particular the factors that influenced their beliefs about medicines and disease modifying anti-rheumatic drugs (DMARDs). Thirty two patients with RA and SLE took part in focus group discussions. Patients who chose to participate in focus groups conducted in English were compared with those who chose to participate groups conducted in Punjabi or Urdu. RESULTS Three main themes emerged to explain patients beliefs about medicines: (1) Beliefs about the necessity of DMARDs; (2) Concerns about DMARDs and other prescribed medicines including: (a) long-term side-effects; (b) the apparent lack of efficacy of some therapies; (c) concerns about changing from one drug to another and the large numbers of different medicines being taken; (3) Contextual factors which informed the patient's view on the necessity for particular medicines and concerns about them including: (a) beliefs about the causes of disease and the influence of religious beliefs on this; (b) barriers to communication with health care professionals about the medications being prescribed in clinic. In addition, our data revealed that these beliefs about DMARDs had important consequences for patient behaviour, including the use of traditional dietary and other non-pharmacological approaches. There were differences in views expressed between those who chose to speak in English and those who did not. CONCLUSION This study has identified themes that explain previous findings of negative beliefs about medicines in patients of South Asian origin. Beliefs about the causes of disease had an important impact on the way some patients viewed medicines for RA and SLE. This will have implications for educational programmes designed to promote patient involvement in disease management.
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Affiliation(s)
- K Kumar
- School of Immunity and Infection, College of Medical and Dental Sciences, The University of Birmingham, Birmingham, UK.
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Oliveira-Santos M, Verani JFS, Klumb EM, Albuquerque EMN. Evaluation of adherence to drug treatment in patients with systemic lupus erythematosus in Brazil. Lupus 2010; 20:320-9. [DOI: 10.1177/0961203310383736] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objectives of this study were to measure the prevalence of adherence to drug treatment and analyze associations with characteristics pertaining to the treatment, disease, health professionals and services, and socio-demographic issues in patients with systemic lupus erythematosus (SLE) in the city of Rio de Janeiro, Brazil. A sample of 246 women with SLE was analyzed. The data were collected through individual interviews and a review of patient charts. Adherence was estimated according to the Morisk criteria, and the associated factors were analyzed by hierarchical modeling. The percentage of patients classified as adherent to treatment was 31.7%. The reasons cited for non-adherence were: carelessness with drug administration times (52.43%), forgetfulness (38.21%), adverse drug reaction (13.8%), and interruption of treatment due to improvement in symptoms (7.72%). Factors associated with adherence were: behavior towards the presence of adverse drug reaction, hematological alterations, presence of mucocutaneous manifestations, legibility of the medical prescription, schooling, and family support. The study concludes that adherence to drug treatment in SLE is a complex and multifactorial phenomenon, and the results corroborate findings from studies conducted in developed countries. The hierarchical modeling proved to be a good alternative for evaluating adherence, since it allowed visualizing the various stages in the analysis.
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Affiliation(s)
- M Oliveira-Santos
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Rio de Janeiro, Brazil
- Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil
| | - JFS Verani
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Rio de Janeiro, Brazil
| | - EM Klumb
- Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil
| | - EMN Albuquerque
- Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil
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Duvdevany I, Cohen M, Minsker-Valtzer A, Lorber M. Psychological correlates of adherence to self-care, disease activity and functioning in persons with systemic lupus erythematosus. Lupus 2010; 20:14-22. [DOI: 10.1177/0961203310378667] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of the study was to assess the effects of Sense of Coherence (SOC), emotional distress and treatment adherence on disease activity and functioning level of persons with systemic lupus erythematosus (SLE). One hundred persons with SLE, aged 18–60, participated in the study. They responded to the SOC scale, hospital anxiety and depression scale (emotional distress) and to questionnaires about adherence to treatment, level of functioning and disease activity. The results show a moderate level of disease activity and everyday functioning, as well as moderate levels of emotional distress. Income, emotional distress and adherence significantly predicted the levels of functioning ( p < 0.001), while income and emotional distress significantly predicted the levels of disease activity only ( p < 0.001). SOC was significantly associated with higher level of functioning ( p < 0.001) and lower disease activity ( p < 0.01), while emotional distress, but not treatment adherence, highly mediated these relationships. The results emphasize the associations of emotional distress and SOC with severity of the symptoms and level of functioning, and the associations between SOC and adherence to treatment. Further confirmation of the results with larger samples and longitudinal designs are warranted.
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Affiliation(s)
- I Duvdevany
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
| | - M Cohen
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
- Department of Gerontology, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
| | - A Minsker-Valtzer
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
| | - M Lorber
- Autoimmune Disease Unit, Rambam Medical Center, Haifa, Israel
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de Achaval S, Suarez-Almazor ME. Treatment adherence to disease-modifying antirheumatic drugs in patients with rheumatoid arthritis and systemic lupus erythematosus. INTERNATIONAL JOURNAL OF CLINICAL RHEUMATOLOGY 2010; 5:313-326. [PMID: 20676388 PMCID: PMC2910438 DOI: 10.2217/ijr.10.15] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Treatment adherence is critical in the management of rheumatic diseases. Recent advances in therapy for rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are promising, although the impact on quality of life may be limited due to nonadherence. Databases including Ovid Medline, Scopus and the Epub-ahead-of-print subset of PubMed were searched for the period of the last 10 years using combined keywords patient compliance, medication adherence, disease modifying antirheumatic drug (DMARD), rheumatoid arthritis and systemic lupus erythematosus. Additional references from retrieved papers were considered. Inclusion criteria were the following: identification of a quantitative measure of adherence to medications including DMARDs and biologics; inclusion of well-defined measures of adherence; and patients with RA or SLE. Studies in RA and SLE patients demonstrated overall inadequate treatment adherence. Adherence was measured using multiple methods including pharmacy records, electronic monitoring, self-report and physician report. The evidence for interventions to improve treatment adherence was limited and demonstrated various results. Future research should further explore determinants of nonadherence and continue to examine the efficacy of implementing various strategies to improve medication management in this patient population.
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Affiliation(s)
- Sofia de Achaval
- The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Chambers SA, Raine R, Rahman A, Isenberg D. Why do patients with systemic lupus erythematosus take or fail to take their prescribed medications? A qualitative study in a UK cohort. Rheumatology (Oxford) 2009; 48:266-71. [PMID: 19151034 DOI: 10.1093/rheumatology/ken479] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE It has been suggested that low adherence may contribute to poor clinical outcomes in patients with SLE. In this study, we explored the reasons why patients with lupus did or did not take their medications as prescribed. METHODS Questionnaires including a 10-cm visual analogue scale (VAS) to assess self-reported adherence to prescribed medications were distributed to 315 patients with SLE. The responses were used to select a purposive sample of subjects who participated in interviews to discuss why they did or did not take their medications. RESULTS Of the 315 patients, 220 (70%) completed the questionnaire. Thirty-three patients were interviewed. Themes explaining why patients took their medications regularly included: the fear of worsening disease, the belief that there was no effective therapeutic alternative to their prescribed medications, lack of knowledge about SLE to allow confidence in changing medications and feelings of moral obligation or responsibility to others. Themes explaining why patients did not take their medications regularly included: the belief that lupus could and should be controlled using alternative methods, the belief that long-term use of drugs was not necessary, the fear of drug adverse effects, practical difficulties in obtaining medications, and poor communication between patients and doctors. CONCLUSION The patients' reasons for taking or not taking their medications largely related to previous experiences with the disease and/or drugs. However, improvements in communication between doctors and patients may promote better adherence in patients with SLE.
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Affiliation(s)
- S A Chambers
- The Centre for Rheumatology, Department of Medicine, University College Hospital, 250 Euston Road, 3rd Floor Central, London NW1 2PQ, UK.
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