Understanding Nonadherence with Hydroxychloroquine Therapy in Systemic Lupus Erythematosus
Understanding Nonadherence with Hydroxychloroquine Therapy in Systemic Lupus Erythematosus
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DOI：
10.3899/jrheum.180946
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发表时间：
2019-10-01
影响因子：
3.9
通讯作者：
Herrinton, Lisa J.
中科院分区：
文献类型：
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作者：
Liu, Lucy H.;Fevrier, Helene B.;Herrinton, Lisa J.
Objective.羟氯喹（HCQ）是治疗系统性红斑狼疮（SLE）的基石，但药物依从性差。我们试图测量依从性与世界卫生组织针对慢性病所阐述的5个“依从性维度”的关联：患者的社会经济地位，以及患者，病情，治疗和医疗保健系统相关因素。我们的长期目标是产生证据，设计有效的干预措施，以增加依从性。回顾性队列研究纳入了2006-2014年期间Kaiser Permanente北方加州≥ 18岁的SLE患者和≥ 2次连续HCQ处方。根据药物持有率计算依从性，并将依从性分为< 80% versus >≥ 80%。预测变量从电子病历和人口普查数据中获得。我们使用多变量logistic回归来估计调整后的OR和95%CI。该研究包括1956名患者。只有58%的患者依从性>= 80%。在调整后的分析中，社会经济变量不能预测依从性。年龄增加（65-89岁与≥ 3岁相比，与0或1相比：OR 1.47，95% CI 1.18-1.83）与依从性呈正相关。提供护理的风湿病学家和医疗中心与依从性无关。在我们的研究中，与其他研究一样，大约一半的SLE患者不依从HCQ治疗。不同种族/民族的依从性差异表明，有可能使用量身定制的干预措施来提高依从性。需要定性研究来阐明患者对依从性支持的偏好。
Objective. Hydroxychloroquine (HCQ) is a cornerstone to managing systemic lupus erythematosus (SLE), yet adherence to medication is poor. We sought to measure the association of adherence with 5 "dimensions of adherence" as articulated by the World Health Organization for chronic conditions: the patient's socioeconomic status, and patient-, condition-, therapy-, and healthcare system-related factors. Our longterm goal is to generate evidence to design effective interventions to increase adherence.Methods. The retrospective cohort study included Kaiser Permanente Northern California patients >= 18 years old during 2006-2014, with SLE and >= 2 consecutive prescriptions for HCQ. Adherence was calculated from the medication possession ratio and dichotomized as < 80% versus >= 80%. Predictor variables were obtained from the electronic medical record and census data. We used multivariable logistic regression to estimate adjusted OR and 95% CI.Results. The study included 1956 patients. Only 58% of patients had adherence >= 80%. In adjusted analyses, socioeconomic variables did not predict adherence. Increasing age (65-89 yrs compared with = 3 compared with 0 or 1: OR 1.47, 95% CI 1.18-1.83) were positively associated with adherence. The rheumatologist and medical center providing care were not associated with adherence.Conclusion. At our setting, as in other settings, about half of patients with SLE were not adherent to HCQ therapy. Differences in adherence by race/ethnicity suggest the possibility of using tailored interventions to increase adherence. Qualitative research is needed to elucidate patient preferences for adherence support.