Date of Award

Summer 8-2022

Document Type


Degree Name

Doctor of Philosophy (PhD)


Pharmaceutical Sciences

First Advisor

Sherry Wang

Second Advisor

Khaled Elsaid

Third Advisor

Souhiela Fawaz

Fourth Advisor

Lawrence Brown

Fifth Advisor

Enrique Seaone-Vazquez


This dissertation sought to understand the management and treatment of patients diagnosed with lupus erythematosus. To accomplish the objectives of this research, three studies were conducted. First, a systematic literature review was done to assess the current landscape of available clinical guidelines for disease treatment. This research then used the National Ambulatory Medical Care Survey data from 2006-2016 to explore real-world trends in medications prescribed, comorbidities and chronic conditions associated with lupus. Data is weighted to be nationally representative of the U.S. The third study explored sociological influences or nonclinical factors on the prescribing of medications for patients with lupus. The Eisenberg Model of Physician Decision-Making helped guide the variables selected for inclusion in the model based on its four constructs: physician characteristics, physician relationship with the healthcare system, patient demographics, and physicians’ relationship with the patient. Patients with lupus were identified using ICD-9 and ICD-10 codes reported during the visit. The outcome variable was medication prescribed which was further assessed by drug category. Statistical analysis included descriptive statistics and logistic regression models.

There were 27,029,228 weighted visits for lupus patients in the study period and 87% of visits had a medication prescribed. Most visits were for female (88%), white (79%), non-Hispanic (88%), and patients with private insurance (53%). The most common medications prescribed were hydroxychloroquine (30%), prednisone (23%), multivitamin (14%), and furosemide (9%). Variables that were found to be significant were physician degree type (p=0.014), practice ownership status (p=0.007), patient status (new or existing) (p=0.02), office setting (p=0.033), physician specialty group (medical, surgical or primary care) (p=0.002), and practice specialty (p=0.004). Visits to a physician with a M.D. degree had lower odds of prescribing a medication (OR 0.90; 95%CI 0.84-0.96). Neurologists were 15% less likely to prescribe a medication (OR 0.85; 95%CI 0.67-1.09) compared to dermatologists. Visits to a practice who was owned by an insurance company, health plan, HMO, other health corporation had higher odds of receiving a prescription (OR 1.07; 95%CI 1.01-1.14). These findings have implications for the clinical management of lupus by characterizing the disease to better understand how to develop strategies to improve care.

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Available for download on Friday, August 30, 2024