Hurried Provider Communication, Low Patient Self-Efficacy Contribute to Medication Nonadherence in SLE

Female doctor talking to a patient
Researchers assessed the modifiable factors associated with persistent medication adherence among patients with SLE.

Nonadherence to medications correlated with hurried provider communication and low patient self-efficacy in systemic lupus erythematosus (SLE), according to study findings published in Arthritis Care & Research (Hoboken).

Researchers at Duke University School of Medicine conducted an analysis of medication adherence among patients with SLE, using data from a prospective cohort in the Duke Lupus Registry.

The researchers assessed patient adherence to medications based on documentation from face-to-face office visits with the prescribing provider at baseline and after approximately 1 year. Initial visits occurred between July 2018 and January 2019; follow-ups took place between September 2019 and January 2020.

The researchers collected baseline patient demographics, including age, sex, insurance status, ethnicity, marital status, income, education level, disability status, disease duration, number of SLE-specific medications, and number of hospitalizations/emergency room visits within the past year.

Of the 77 patients (53% Black; 96% women) with SLE, 48% demonstrated persistent nonadherence to medications.

Based on demographic information, researchers observed that patients who were more likely to demonstrate nonadherence were younger, Black, had lower income, and were receiving treatment with 2 or more medications for SLE.

Patients with nonadherence typically scored higher in SLE-related damage on the Systemic Lupus International Collaborating Clinics (SLICC) Damage Index at baseline. Patients also scored higher at their follow-up visits on the Physician Global Assessment (PGA).

Persistent nonadherence correlated with perception of hurried communication between patients and providers, especially with regard to providers’ use of difficult words and fast speech, as observed with patient responses on the Interpersonal Processes of Care Survey.

Patients with nonadherence to medications also demonstrated lower self-efficacy in managing their medications, as seen on the Patient Reported Outcomes Measurement Information System (PROMIS) short forms.

Study limitations included the small sample size, lack of generalizability, the single-center design, lack of ethnic diversity, and not accounting for the impact of polypharmacy on adherence. In addition, data collected did not reflect inconsistent adherence, but persistent adherence/nonadherence.

“Potential avenues to improve medication adherence include optimizing patient provider communication, specifically avoiding difficult vocabulary and fast speech, and enhancing patient self-efficacy, particularly among younger Black patients with lower income who are at higher risk for nonadherence,” the study authors said.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Barr AC, Clowse M, Maheswaranathan M, et al. Hurried communication and low patient self-efficacy are associated with persistent nonadherence to lupus medications. Arthritis Care Res (Hoboken). Published online October 4, 2022. doi:10.1002/acr.25030