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Feasibility, Acceptability, and Preliminary Efficacy of an Innovative Adherence Intervention for Young Adults with Childhood-Onset Systemic Lupus Erythematosus

Harry, Onengiya, M.D.
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1562674805687393

Abstract Details

2019, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Background: Poor medication adherence increases morbidity and mortality, adding billions to healthcare costs. Most patients do not take their medicine as prescribed making this a significant health issue. In Childhood-Onset Systemic Lupus Erythematosus (cSLE), poor medication adherence rates are even higher. Although reasons for poor adherence are numerous, our previous work identified modifiable barriers including forgetting and lack of drug-specific knowledge. Interventions targeting medication adherence in cSLE are lacking and as such effective interventions are needed. The objective of this study was to examine the feasibility, acceptability, and preliminary efficacy of an intervention (automated digital reminders + personalized prescribed treatment plan (pPTP) to improve medication adherence in young adults with cSLE over 3 months. Method: This proof of concept study is a RCT design. 19 young adults with cSLE (mean age 20; 39% Caucasian; 61% Black American; 20% Male) are enrolled. All participants receive SimpleMed+ pillboxes that track adherence using cellular technology. Adherence data will be collected from both groups. The intervention group will receive a pPTP, and in month 2, pre-selected digital reminders for missed medication doses. Reminders are discontinued after 30 days and adherence data collected post-intervention. Questionnaires and chart review data are collected. Data analysis was done using mixed model and maximum likelihood estimation. Results: 21 participants were approached for participation and 19 consented to participate. Recruitment rate was 86% during the enrollment period. Overall, retention, and pillbox use rates were 95% (18/19) and 95% (18/19) respectively. 100% of the participants in the treatment group found the pillbox easy to use, although 86% (6/7) thought it was without glitches. None of the participants reported becoming bored with the pillbox or reminders during the duration of the study. At baseline, both groups were similar except in gender (p<0.03), fatigue (p<0.001), and barrier of forgetting to take medication (p=0.01). Forgetting to take medication, taste of medication, medication side effects, and fertility concerns were top barriers to medication adherence. There was no significant difference in self-report of adherence (MASRI adherence score) between both groups at baseline (p=0.73) or post-intervention (p=0.22). Mean of measured adherence improved for the treatment group from baseline to post-intervention (61.5 to 65.3) although this difference was small and not statistically significant (p=0.63). Nonetheless, there was sustained increase in measured adherence in the 1 month post-intervention. Conclusions: This feasibility study represents the first use of an electronic pillbox to track adherence to multiple medications and daily doses in young adults with cSLE. The high feasibility and acceptability rating of the pillbox makes it a feasible and acceptable method of measuring adherence. Overall, feasibility and acceptability ratings for the intervention were mixed suggesting that there is a subset of cSLE patients for whom an electronic pillbox with digital reminders would be beneficial. Future research should focus on large-scale testing of the pillbox with automated digital reminders as an adherence intervention for patients with cSLE. If effective, this methodology has promise to increase medication adherence while ultimately decreasing negative health outcomes associated with poor adherence.
Aimin Chen, Ph.D. (Committee Chair)
Lori Crosby, Psy.D. (Committee Member)
Constance Mara (Committee Member)
Avani Modi (Committee Member)
25 p.
Surgery
Lupus and adherence; Childhood lupus and adherence; Adherence intervention and childhood lupus

Recommended Citations

Citations

  • Harry, M.D., O. (2019). Feasibility, Acceptability, and Preliminary Efficacy of an Innovative Adherence Intervention for Young Adults with Childhood-Onset Systemic Lupus Erythematosus [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1562674805687393

    APA Style (7th edition)

  • Harry, M.D., Onengiya. Feasibility, Acceptability, and Preliminary Efficacy of an Innovative Adherence Intervention for Young Adults with Childhood-Onset Systemic Lupus Erythematosus. 2019. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1562674805687393.

    MLA Style (8th edition)

  • Harry, M.D., Onengiya. "Feasibility, Acceptability, and Preliminary Efficacy of an Innovative Adherence Intervention for Young Adults with Childhood-Onset Systemic Lupus Erythematosus." Master's thesis, University of Cincinnati, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1562674805687393

    Chicago Manual of Style (17th edition)

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This open access ETD is published by University of Cincinnati and OhioLINK.