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

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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; D'Cruz, David.

In: Rheumatology, Vol. 2021, 534, 10.07.2021.

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Sloan, Melanie ; Lever, Elliott ; Gordon, Caroline ; Harwood, Rupert ; Georgopoulou, Sofia ; Naughton, Felix ; Wincup, Chris ; Sutton, Stephen ; D'Cruz, David. / Medication decision-making and adherence in lupus : patient-physician discordance and the impact of previous ‘Adverse Medical Experiences’. In: Rheumatology. 2021 ; Vol. 2021.

Bibtex

@article{d4fc0673f9694bcca030ea96ba88e9d8,
title = "Medication decision-making and adherence in lupus: patient-physician discordance and the impact of previous {\textquoteleft}Adverse Medical Experiences{\textquoteright}",
abstract = "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. Mixed methodology involved thematic analysis of in-depth interviews (N = 23) to further explore the statistically analysed quantitative survey findings (N = 186). 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). 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. [Abstract copyright: {\textcopyright} The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.]",
keywords = "SLE, Rheumatology, Medication adherence, patient-behaviour, Patient-physician interactions",
author = "Melanie Sloan and Elliott Lever and Caroline Gordon and Rupert Harwood and Sofia Georgopoulou and Felix Naughton and Chris Wincup and Stephen Sutton and David D'Cruz",
year = "2021",
month = jul,
day = "10",
doi = "10.1093/rheumatology/keab534",
language = "English",
volume = "2021",
journal = "Rheumatology",
issn = "1462-0324",
publisher = "Oxford University Press",

}

RIS

TY - JOUR

T1 - Medication decision-making and adherence in lupus

T2 - patient-physician discordance and the impact of previous ‘Adverse Medical Experiences’

AU - Sloan, Melanie

AU - Lever, Elliott

AU - Gordon, Caroline

AU - Harwood, Rupert

AU - Georgopoulou, Sofia

AU - Naughton, Felix

AU - Wincup, Chris

AU - Sutton, Stephen

AU - D'Cruz, David

PY - 2021/7/10

Y1 - 2021/7/10

N2 - 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. Mixed methodology involved thematic analysis of in-depth interviews (N = 23) to further explore the statistically analysed quantitative survey findings (N = 186). 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). 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. [Abstract copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.]

AB - 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. Mixed methodology involved thematic analysis of in-depth interviews (N = 23) to further explore the statistically analysed quantitative survey findings (N = 186). 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). 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. [Abstract copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology.]

KW - SLE

KW - Rheumatology

KW - Medication adherence

KW - patient-behaviour

KW - Patient-physician interactions

U2 - 10.1093/rheumatology/keab534

DO - 10.1093/rheumatology/keab534

M3 - Article

VL - 2021

JO - Rheumatology

JF - Rheumatology

SN - 1462-0324

M1 - 534

ER -