Medication decision-making and adherence in lupus: Patient-physician discordance and the impact of previous ‘Adverse Medical Experiences’

Sloan, Melanie, Lever, Elliott, Gordon, Caroline, Harwood, Rupert, Georgopoulou, Sofia, Naughton, Felix, Wincup, Chris, Sutton, Stephen and D’Cruz, David (2021) Medication decision-making and adherence in lupus: Patient-physician discordance and the impact of previous ‘Adverse Medical Experiences’. Rheumatology. ISSN 1462-0324

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Objectives: Medication adherence is critical in the successful management of lupus. There is very limited existing literature on reasons why non-adherence is not reported. This study explores the impact of current and previous medical experiences on patient satisfaction, adherence and reporting of non-adherence. Methods: Mixed methodology involved thematic analysis of in-depth interviews (N = 23) to further explore the statistically analysed quantitative survey findings (N = 186). Results: This study identified five themes: 1) physician-patient discordance and a ‘hierarchy of evidence’ in medication decisions, 2) the association of adherence with satisfaction with care, 3) the persisting impact of past Adverse Medical Experiences (AMEs), 4) the dynamic balance of patient-physician control, and 5) holistic care – beyond a purely medication- based focus. Improving quality of life (43% of participants) and a supportive medical relationship (24%) were the main reasons for adherence. Patient-priorities and self-reported symptoms were perceived as less important to physicians than organ-protection and blood results. Non-reporters of non-adherence, non-adherers and those with past AMEs (e.g. psychosomatic misdiagnoses) had statistically significant lower satisfaction with care. The importance of listening to patients was a key component of every theme, and associated with patient satisfaction and adherence. The mean rating for rheumatologist’s listening skills was 2.88 for non-adherers compared to 3.53 for other participants (mean difference 0.65, P = 0.003). Conclusion: Patients would like more weight and discussion given to self-reported symptoms and quality of life in medication decisions. Greater understanding and interventions are required to alleviate the persisting impact of past AMEs on some patients’ wellbeing, behaviour and current medical relationships.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
Depositing User: LivePure Connector
Date Deposited: 14 Jul 2021 00:29
Last Modified: 10 Sep 2021 00:21
DOI: 10.1093/rheumatology/keab534

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