Background/Purpose: Systemic lupus erythematosus (SLE) is an autoimmune disease, characterized by episodes of flares, often involving multiple organ systems. Medication nonadherence remains a significant problem, reported by 43% to 75% of patients with one third self-discontinuing treatment after 5 years. Medication nonadherence has been linked to increased morbidity and hospital readmission. In addition to known predictors of nonadherence, including low socioeconomic status and side effects of medications, we hypothesized that pill burden, medical/psychiatric comorbidities and patient beliefs also play a role. Using survey methodology, our study examines factors that impact medication adherence among hospitalized patients with SLE. By characterizing these factors qualitatively and quantitatively, we hope to identify ways to decrease barriers to nonadherence.

Methods: This study was approved by the local Institutional Review Board. Hospitalized patients with SLE were identified and invited to participate. Demographics, education level, employment, insurance status, and self-reported outpatient medication use were obtained by patient interview. Patient-reported medication use was compared to outpatient prescriptions from the medical record to determine pill burden and adherence. Qualitative information was collected on beliefs surrounding medications and the presence of family and community support. Patients were instructed to complete the STOFHLA health literacy questionnaire. Two-sample t-tests for continuous variables and Fisher’s exact test for categorical measures were performed as appropriate.

Results: 20 patients with SLE met eligibility criteria and consented to participate. Most of our patients were black (n=18, 90%) and all were female, with a mean age of 36.4 ± 15.3. In his cohort, 55% of patients reported lack of medication adherence within 2 weeks of hospitalization. Nonadherent patients were more likely to have 3 or more additional medical/psychiatric comorbidities (p< 0.01). Nonadherent patients were also more likely to report that taking their medication was a hassle or inconvenience (p< 0.05). Factors such as age, employment, insurance status, or self-reported presence of family and/or community support were not significantly associated with adherence. There was no statistical difference in hospital length of stay (7.4 vs. 8.1 days) or pill burden per week (135 vs. 123 pills/week) between adherent and nonadherent patients. Health literacy, as measured by the STOFHLA, was not significantly different between adherent and nonadherent patients.

Conclusion: Within this predominantly African American female cohort of patients with SLE, there was high pill burden and prevalence of medication nonadherence prior to hospitalization. Despite the small sample size, this ongoing study provides insight into barriers important to patients and modifiable risk factors that healthcare providers can target when treating patients with SLE and addressing nonadherence.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/factors-that-impact-medication-adherence-in-hospitalized-patients-with-systemic-lupus-erythematosus/