Megan E. B. Clowse

Objective This study seeks to assess rheumatology fellows’ (RFs’) and program directors’ (PDs’) interests in different educational tools and methods and to facilitate curriculum development for reproductive health related to rheumatic disease. Methods Constructs were conceptualized in four dimensions: 1) RF and PD confidence in their current curriculum relating to the American College of Rheumatology (ACR) Reproductive Health Guidelines (RHGs), 2) personal interest in this topic, 3) opinions of the importance of this topic, and 4) interest in a range of learning materials and educational experiences. The final survey was distributed to 753 RFs and 179 PDs in the United States using the ACR Committee on Training and Workforce email list. Results Response rates were 13% (n = 98) for RFs and 25% (n = 44) for PDs. Both groups indicated more interest in the topic than confidence in their curriculum and rated summary sheets, question banks, didactics, and online modules higher than nine other educational tools or methods. Despite interest in the topic, 38% of RF respondents and 24% of PD respondents were unaware of the recently published ACR RHGs. Conclusion RFs and PDs consider reproductive health very important and report high personal interest in this topic. In contrast, both groups indicated lower confidence in current curricula, and substantial proportions of both groups were unaware of recently published guidelines. RFs’ and PDs’ interests in specific educational modalities are aligned. Curriculum development efforts should prioritize summary sheets, question banks, didactics, and online modules. Efforts are needed to address the educational needs of practicing rheumatologists and other professionals caring for patients with rheumatic disease.

Objective Medication nonadherence is common among patients with systemic lupus erythematosus (SLE), and adherence often fluctuates with time. Underrepresented racial minorities have disproportionately lower rates of medication adherence and more severe SLE manifestations. We aimed to identify modifiable factors associated with persistent medication nonadherence. Methods Patients taking ≥1 SLE medication were enrolled. Adherence data were obtained at baseline and at follow‐up roughly 1 year later using both self‐reported adherence and pharmacy refill data. Covariates included patient–provider interaction, patient self‐efficacy, and clinical factors. We compared characteristics of patients in 3 groups using the Kruskal‐Wallis H test: persistent nonadherence (low adherence by self‐report and refill rates at both time points); persistent adherence (high adherence by self‐report and refill rates at both time points); and inconsistent adherence (the remainder). Results Among 77 patients (median age 44 years, 53% Black, 96% female), 48% had persistent nonadherence. Compared with other adherence groups, patients with persistent nonadherence were younger and more likely to be Black, have lower income, take ≥2 SLE medications, have higher SLE‐related damage at baseline, and have higher physician global assessment of disease activity at follow‐up. Persistently nonadherent patients also rated more hurried communication with providers (particularly fast speech and difficult word choice) and had lower self‐efficacy in managing medications. Conclusion 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.