Background/Purpose: Medication non-adherence is common among SLE patients and contributes to poor outcomes. Underrepresented racial minorities have disproportionately lower rates of medication adherence and often have more severe manifestations of SLE. In this longitudinal analysis, we aimed to identify modifiable factors associated with persistent medication non-adherence.

Methods: Consecutive SLE patients taking ≥1 SLE medications at a tertiary lupus clinic were enrolled. Baseline data collected 7/2018-1/2019 included demographics, patient-provider communication as measured by the Interpersonal Processes of Care survey, self-efficacy, and SLICC damage scores. Follow-up data collected 9/2019-1/2020 included SLEDAI and physician global assessment (PGA) of disease activities. Adherence data obtained at both baseline and follow-up included: 1) self-reported adherence in the preceding month from 0-100%, with ≥90% indicating High Self-Reported Adherence; and 2) pharmacy refill data in the preceding 3 months, with a medication possession ratio (MPR) of ≥80% indicating High Refills. High Composite Adherence was defined as having both High Self-reported Adherence and High Refills. Those with High Composite Adherence at both baseline and follow-up were considered to have Persistent Adherence, those with Low Composite Adherence at both time points were considered to have Persistent Non-Adherence, and the rest were considered to have Inconsistent Adherence. We compared characteristics of adherence groups.

Results: Data from 77 SLE patients were analyzed (43% white, 53% African-American, and 4% other). Median age was 44 years, 96% were female, 60% had ≥ college education, and 51% had private insurance. On average, patients were prescribed 2 SLE medications, with 84% prescribed HCQ, 57% prescribed a DMARD, and 4% prescribed Belimumab. At baseline, 73% had High Self-Reported Adherence, 51% High Refills, and 43% High Composite Adherence. Longitudinally, 32% had Persistent Adherence, 47% had Persistent Non-Adherence, and 21% had Inconsistent Adherence. Comparing adherence groups, those with Persistent Non-Adherence were younger, more likely to be African-American, took more SLE medications, and had higher PGA scores. Patients with Persistent Non-Adherence also rated more hurried communication with providers – specifically with respect to speaking fast and using hard words – and had lower self-efficacy in managing treatments and medications (Table 1).

Conclusion: Our results show that adherence rates to SLE medications are low, and persistent non-adherence is disproportionately more common among African-Americans. Potential areas for intervention in order to improve adherence include optimizing patient-provider communication, specifically avoiding difficult vocabulary and fast speech, and enhancing patient self-efficacy, particularly among young African-Americans with SLE who are at higher risk for non-adherence.

Table 1. Comparing those with Persistent Adherence, Inconsistent Adherence, and Persistent Non-Adherence based on the Composite Adherence measure at baseline and follow-up.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hurried-communication-and-low-patient-self-efficacy-are-associated-with-persistent-non-adherence-to-sle-medications/