Pilot Intervention to Improve Medication Adherence Among Patients With Systemic Lupus Erythematosus Using Pharmacy Refill Data.



Despite high rates of medication nonadherence among patients with systemic lupus erythematosus (SLE), effective interventions to improve adherence in SLE are limited. We aimed to assess the feasibility of a pilot intervention and explore its effect on adherence.


The intervention used pharmacy refill data to monitor nonadherence and prompt discussions surrounding SLE medications during clinic encounters. Over 12 weeks, the intervention was delivered through routine clinic visits by providers to patients with SLE who take SLE-specific medications. We measured acceptability, appropriateness, and feasibility using provider surveys. We also measured acceptability by patient surveys and feasibility by medical record documentation. We explored change in adherence by comparing percent of patients with medication possession ratio (MPR) ≥80% 3 months before and after the intervention visit using the McNemar's test.


Six rheumatologists participated; 130 patients were included in the analysis (median age 43, 95% female, and 59% racial and ethnic minorities). Implementation of the intervention was documented in 89% of clinic notes. Provider surveys showed high scores for feasibility (4.7/5), acceptability (4.4/5), and appropriateness (4.6/5). Among patient surveys, the most common reactions to the intervention visit were feeling determined (32%), empowered (32%), and proud (19%). Proportion of patients with MPR ≥80% increased from 48% to 58% (P = 0.03) after the intervention visit.


Our intervention showed feasibility, acceptability, and appropriateness and led to a statistically significant improvement in adherence. Future work should refine the intervention, assess its efficacy in a controlled setting, and adapt its use among other clinic settings.





Published Version (Please cite this version)


Publication Info

Sun, Kai, Amanda M Eudy, Jennifer L Rogers, Lisa G Criscione-Schreiber, Rebecca E Sadun, Jayanth Doss, Mithu Maheswaranathan, Ann Cameron Barr, et al. (2023). Pilot Intervention to Improve Medication Adherence Among Patients With Systemic Lupus Erythematosus Using Pharmacy Refill Data. Arthritis care & research, 75(3). pp. 550–558. 10.1002/acr.24806 Retrieved from https://hdl.handle.net/10161/29368.

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Kai Sun

Assistant Professor of Medicine

My clinical interests are in general rheumatology, lupus, and musculoskeletal ultrasound. My research interest is in healthcare disparities and medication adherence in rheumatology.


Amanda Marie Eudy

Assistant Professor in Medicine

Jennifer Lee Rogers

Associate Professor of Medicine

Lisa Giorgina Criscione-Schreiber

Professor of Medicine

My clinical interests include systemic lupus erythematosus (SLE) and inflammatory myopathies.  I also  maintain a general rheumatology continuity clinic for individuals with rheumatoid arthritis, vasculitis, and other forms of inflammatory arthritis and autoimmune diseases.  In 2007, I co-founded the Duke Lupus Clinic with Dr. Megan Clowse.  We have continued this clinic with the aim to improve the health and quality of life for individuals living with lupus. 

My primary research interests are in education and in SLE.  My particular interest within education is learner assessment.  I was previously funded by a Clinician Scholar Educator Award through the Rheumatology Research Foundation of the American College of Rheumatology.  My CSE project explored validation of a rheumatology objective structured clinical examination (ROSCE). I continue to collaborate with the Rheumatology Program Directors at UNC Chapel Hill, Wake Forest University, the Medical University of South Carolina and Massachusetts General Hospital through our Carolinas Fellows Collaborative. Members of this group composed the competency-based goals and objectives (CBGO) for all learning activities of rheumatology fellowship training programs, which were adopted by the American College of Rheumatology and are posted on their website. I have been very involved in rheumatology curricular efforts through the American College of Rheumatology. I served on the Milestones working group and am a past member and past Chair of the ACR Curriculum Subcommittee of the Committee on Training and Workforce. I previously participated on the ACR/NBME rheumatology in-training examination working group.               

Clinical research in lupus has included the Duke Lupus Registry population.  Our recent work focuses on creating and defining the type 1 and type 2 lupus paradigms for classifying lupus disease activity.  Additional interests through the Duke Lupus Clinic include elucidating clinician-level factors that can influence medication adherence as well as determining how health literacy and numeracy impact adherence and patient level outcomes.  I collaborate with Dr. Megan Clowse, who studies reproductive health in women with autoimmune diseases.  We have combined her subject matter expertise with my educational skills to create HOP-STEP, a program to teach patients with lupus and their rheumatologists about pregnancy planning to improve health outcomes.  We have created lupuspregnancy.org, which houses many resources and videos designed to teach rheumatologists to better partner with women with lupus to have open and honest discussions about pregnancy planning.  Our ultimate aim is to improve the health outcomes for women with lupus and their offspring. 


Rebecca Eli Sadun

Assistant Professor of Medicine

I am an adult and pediatric rheumatologist with clinical and research interests in the areas of lupus and transition to adult care.  My time is split between the departments of Medicine and Pediatrics.  In addition to seeing patients in both environments, I run a dedicated Young Adult Rheumatology Clinic in collaboration with Duke Family Medicine.


Mithunan Maheswaranathan

Assistant Professor of Medicine

Amy Lynn Corneli

Professor in Population Health Sciences

A social scientist by training, Dr. Amy Corneli has conducted qualitative and mixed-method research in multiple countries in sub-Saharan Africa, the Middle East, South and Southeast Asia, and in the U.S. She has a long trajectory of working with community partners on research with populations who are disenfranchised due to race, ethnicity, sexuality, and/or gender, and of engaging key contributors in research to inform clinical trials and practice, socio-behavioral interventions, questionnaire/scale development, and the translation of proven interventions into practice. Her current research portfolio focuses on three areas: 1) leading qualitative and implementation science research in HIV prevention and other infectious diseases (gonorrhea and COVID-19), 2) serving as a methodological investigative partner on qualitative and mixed-methods research with faculty in the School of Medicine, and 3) serving as the leader of the social science team and PI of qualitative studies for the Clinical Trials Transformation Initiative, a public-private initiative between Duke University and the U.S. Food and Drug Administration. In addition, she is the 1) founder and Director of QualCore, a group of PhD- and master-level social scientists who provide scientific direction and interviewing and analysis expertise in qualitative research to Duke investigators, 2) co-founder and Director of The BASE (Bioethics and Stakeholder Engagement) Lab, a group of faculty and staff that partners with clinical investigators at Duke to conduct research with key stakeholders to inform the planning, conduct, interpretation, and reporting of clinical research, and 3) Director of the Duke CFAR Social and Behavioral Sciences Core.

QualCore | https://populationhealth.duke.edu/research/qualcore

The BASE Lab | https://populationhealth.duke.edu/research/base-lab

Duke CFAR Social and Behavioral Sciences Core | https://cfar.duke.edu 

Clinical Trials Transformation Initiative| https://www.ctti-clinicaltrials.org 

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