scholarly journals Medication Nonadherence Is Associated With Increased Subsequent Acute Care Utilization Among Medicaid Beneficiaries With Systemic Lupus Erythematosus

2015 ◽  
Vol 67 (12) ◽  
pp. 1712-1721 ◽  
Author(s):  
Candace H. Feldman ◽  
Jinoos Yazdany ◽  
Hongshu Guan ◽  
Daniel H. Solomon ◽  
Karen H. Costenbader
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Acute Care ◽  
Lupus Erythematosus ◽  
Care Utilization ◽  
Systemic Lupus ◽  
Medication Nonadherence ◽  
Acute Care Utilization ◽  
Medicaid Beneficiaries

scholarly journals Patterns and predictors of recurrent acute care use among Medicaid beneficiaries with systemic lupus erythematosus

2020 ◽  
Vol 50 (6) ◽  
pp. 1428-1436 ◽  
Author(s):  
Candace H. Feldman ◽  
Chang Xu ◽  
Jessica Williams ◽  
Jamie E. Collins ◽  
Karen H. Costenbader
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Acute Care ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Medicaid Beneficiaries

scholarly journals Depression and medication nonadherence in childhood-onset systemic lupus erythematosus

Lupus ◽  
2018 ◽  
Vol 27 (9) ◽  
pp. 1532-1541 ◽  
Author(s):  
A M Davis ◽  
T B Graham ◽  
Y Zhu ◽  
M L McPheeters
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Medication Adherence ◽  
Lupus Erythematosus ◽  
Depression Symptoms ◽  
Childhood Onset ◽  
Systemic Lupus ◽  
Medication Nonadherence ◽  
Disease Characteristics ◽  
Prevalence Of Depression ◽  
Onset Systemic Lupus Erythematosus

Objectives Depression and medication nonadherence are important in managing chronic diseases, but little is known about these factors in childhood-onset systemic lupus erythematosus (cSLE). The objectives of this cross-sectional study were to estimate prevalence of depression and medication nonadherence, describe demographic and disease characteristics associated with depression and medication nonadherence, and evaluate the association between depression and medication nonadherence in cSLE patients. Methods Patients with cSLE ( n = 51) completed validated screening questionnaires to identify depression and medication nonadherence, Patient Health Questionnaire-9 and Medication Adherence Self-Report Inventory, respectively. Demographic and disease characteristics were obtained via chart abstraction, and compared between groups of depression or medication nonadherence status. A multivariable linear regression model adjusting for propensity scores was conducted to evaluate the association between depression and medication nonadherence. Results The prevalence of a positive depression screen was 58.8%, and seven patients reported suicidal ideation (13.7%). The prevalence of self-reported medication nonadherence was 19.7%. No statistically significant differences for demographic and disease characteristics were found between patients with a positive vs. negative depression screen. Patients reporting medication nonadherence were more likely to have longer disease duration (4.8 vs. 2.6 years, p = 0.035). As the severity of depression symptoms increased, the degree of medication nonadherence also increased (beta = –1.89; p = 0.011). Conclusions The prevalence of depression and medication nonadherence is high in cSLE, and these factors have a direct relationship. Interventions that better recognize and treat depression and increase rates of medication adherence are needed to improve outcomes in cSLE.

Association between hydroxychloroquine levels and disease activity in a predominantly Hispanic systemic lupus erythematosus cohort

Lupus ◽  
2019 ◽  
Vol 28 (7) ◽  
pp. 862-867 ◽  
Author(s):  
L Geraldino-Pardilla ◽  
A Perel-Winkler ◽  
J Miceli ◽  
K Neville ◽  
G Danias ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Medication Adherence ◽  
Disease Activity ◽  
Lupus Erythematosus ◽  
Reliable Method ◽  
Activity Index ◽  
Clinical Care ◽  
Care Utilization ◽  
Systemic Lupus ◽  
Predominantly Hispanic

Objectives Hydroxychloroquine (HCQ) is a key therapy in systemic lupus erythematosus (SLE). Medication non-adherence is reported in up to 80% of lupus patients and results in increased morbidity, mortality, and health care utilization. HCQ levels are a sensitive and reliable method to assess medication adherence. Our study evaluated the role of HCQ level measurement in routine clinical care and its association with disease activity in a predominantly Hispanic population. Methods SLE patients from the Columbia University Lupus cohort treated with HCQ for ≥ 6 months and reporting medication adherence were included. HCQ levels were measured by whole blood high performance liquid chromatography. Non-adherence was defined as an HCQ level <500 ng/ml. The association between HCQ levels and disease activity measured by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) was evaluated. Results One hundred and eight patients were enrolled; the median age was 38 years, 91% were female, and 63% were Hispanic. The median SLEDAI-2K was 4.3 (0–20). Forty-one percent of patients had an HCQ level <500 ng/ml consistent with non-adherence, of which 19% had undetectable levels. A higher SLEDAI-2K score was associated with low HCQ levels ( p = 0.003). This association remained significant after adjusting for depression ( p = 0.0007). Conclusion HCQ levels < 500 ng/ml were associated with higher disease activity and accounted for 32% of the SLEDAI-2K variability. HCQ blood measurement is a simple and reliable method to evaluate medication adherence in SLE. Reasons for non-adherence (levels < 500 ng/ml) should be further explored and addressed.

scholarly journals Patterns of Healthcare Use and Medication Adherence among Youth with Systemic Lupus Erythematosus during Transfer from Pediatric to Adult Care

2020 ◽  
Vol 48 (1) ◽  
pp. 105-113 ◽  
Author(s):  
Joyce C. Chang ◽  
Andrea M. Knight ◽  
Erica F. Lawson
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Medication Adherence ◽  
Acute Care ◽  
Lupus Erythematosus ◽  
Negative Binomial ◽  
Private Insurance ◽  
Pediatric Care ◽  
Healthcare Use ◽  
Systemic Lupus ◽  
Adult Care

Objective.Youth with systemic lupus erythematosus (SLE) transferring from pediatric to adult care are at risk for poor outcomes. We describe patterns of rheumatology/nephrology care and changes in healthcare use and medication adherence during transfer.Methods.We identified youth ages 15–25 with SLE using US private insurance claims from Optum’s deidentified Clinformatics Data Mart. Rheumatology/nephrology visit patterns were categorized as (1) unilateral transfers to adult care within 12 months, (2) overlapping pediatric and adult visits, (3) lost to followup, or (4) continuing pediatric care. We used negative binomial regression and paired t tests to estimate changes in healthcare use and medication possession ratios (MPR) after the last pediatric (index) visit. We compared MPR between youth who transferred and age-matched peers continuing pediatric care.Results.Of the 184 youth transferred out of pediatric care, 41.8% transferred unilaterally, 31.5% had overlapping visits over a median of 12 months before final transfer, and 26.6% were lost to followup. We matched 107 youth continuing pediatric care. Overall, ambulatory care use decreased among those lost to followup. Acute care use decreased across all groups. MPR after the index date were lower in youth lost to followup (mean 0.24) compared to peers in pediatric care (mean 0.57, p < 0.001).Conclusion.Youth with SLE with continuous private insurance coverage do not use more acute care after transfer to adult care. However, a substantial proportion fail to see adult subspecialists within 12 months and have worse medication adherence, placing them at higher risk for adverse outcomes.

scholarly journals Dynamic patterns and predictors of hydroxychloroquine nonadherence among Medicaid beneficiaries with systemic lupus erythematosus

2018 ◽  
Vol 48 (2) ◽  
pp. 205-213 ◽  
Author(s):  
Candace H. Feldman ◽  
Jamie Collins ◽  
Zhi Zhang ◽  
S.V. Subramanian ◽  
Daniel H. Solomon ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Medicaid Beneficiaries ◽  
Dynamic Patterns

scholarly journals Living with Systemic Lupus Erythematosus: A Profile of Young Female Patients

2020 ◽  
Vol 17 (4) ◽  
pp. 1315 ◽  
Author(s):  
Zelmira Macejova ◽  
Andrea Madarasova Geckova ◽  
Daniela Husarova ◽  
Michaela Zarikova ◽  
Zuzana Kotradyova
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Inflammatory Marker ◽  
Demographic Data ◽  
Care Utilization ◽  
Activity Measurement ◽  
Clinical Activity ◽  
Sufficient Information ◽  
Systemic Lupus ◽  
The Impact

The aim is to describe a profile of systemic lupus erythematosus (SLE) patient (socio-demographic data, course of disease, health status, and health care utilization, SLE impact on their life, SLE awareness) and to explore the association of patient’s perspective with clinical indicators. Adult patients diagnosed by SLE were recruited in outpatient clinics (n = 76, 88% female, data collected in 2012–2016, Slovakia). The association of patients’ perspective (SLE status, health complaints during remission, SLE impact, hospitalizations) with clinical activity (European Consensus Lupus Activity Measurement Index—ECLAM) and inflammatory marker (erythrocyte sedimentation rate—ESR) was assessed by t-test for independent variables and one-way ANOVA. Almost 17.9% of patients reported relapse. During remission, they mostly suffered fatigue and pain. Nearly all patients were on chronic pharmacological treatment. Most of the patients assessed SLE impact on their life as restrictive (56.9%) or very restrictive (23.1%). The most frequent source of information was their physician, and 67.2% reported that they have sufficient information about the disease and its treatment. Only the association of SLE status and hospitalization with clinical activity (ECLAM) and inflammatory marker (ESR) were confirmed. With recent improvements in diagnostics and therapy options, the prognosis for patients with SLE has improved. Nevertheless, the impact of this disease on all areas of a patient’s life is extensive.

Prevalence and associated factors of medication nonadherence among Thai patients with systemic lupus erythematosus

Lupus ◽  
2020 ◽  
pp. 096120332097307
Author(s):  
Orawan Sae-lim ◽  
Intouch Laobandit ◽  
Punyawee Kitchanwit ◽  
Manthana Laichapis ◽  
Boonjing Siripaitoon
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Medication Adherence ◽  
Lupus Erythematosus ◽  
Associated Factors ◽  
Treatment Strategies ◽  
Universal Coverage ◽  
Main Concern ◽  
Systemic Lupus ◽  
Medication Nonadherence ◽  
Reimbursement Scheme

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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