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BackgroundAmong kidney transplant recipients, non-adherence with immunosuppressive medications frequently precedes allograft loss. We sought to determine the prevalence and correlates of medication non-adherence among kidney transplant recipients.MethodsWe performed a single-center, cross-sectional study of kidney transplant recipients who were at least 6 months post-transplant. We measured self-reported adherence using the Immunosuppressive Therapy Adherence Scale (ITAS, which is scored from 0 to 12, where higher scores indicate increased adherence) and barriers to adherence using the Immunosuppressive Therapy Barriers Scale (ITBS). We also used validated scales to measure perceived stress, health literacy, anxiety, depression, and interpersonal support.ResultsThe 252 patients included in the study were 59.9% male, 27.0% Black, and at a median of 2.9 years post-transplant (interquartile range [IQR] 1.4-5.8). On the ITAS, 59.1% scored a perfect 12, 26.6% scored 10–11, and 14.3% scored 0–9. In univariate models, non-adherence (defined as ITAS score ≤9) was significantly associated with increased scores on scales for perceived stress (OR 1.12, 95% CI 1.01-1.25) and depression (OR 1.14, 95% CI 1.02-1.28), and with more self-reported barriers to adherence on the ITBS (OR 1.15, 95% CI 1.08-1.22). After adjusting for sociodemographic factors, stress and depression were not associated with non-adherence. Higher scores on the ITBS (corresponding to more self-described barriers to adherence) were associated with lower scores on the ITAS (P < 0.001). Several individual barriers were associated with non-adherence.ConclusionsAmong prevalent kidney transplant recipients, a minority is non-adherent. Practical barriers to adherence may serve as promising targets for future interventions.

BACKGROUND:Little is known about first-fill adherence rates for diabetic medications and factors associated with non-fill.OBJECTIVE: To assess the proportion of patients who fill their initial prescription for a diabetes medication, understand characteristics associated with prescription first-fill rates, and examine the effect of first-fill rates on subsequent A1c levels. DESIGN:Retrospective, cohort study linking electronic health records and pharmacy claims. PARTICIPANTS:One thousand one hundred thirty-two patients over the age of 18 who sought care from the Geisinger Clinic, had Geisinger Health Plan pharmacy benefits, and were prescribed a diabetes medication for the first time between 2002 and 2006. MEASUREMENTS:The primary outcome of interest was naïve prescription filled by the patient within 30 days of the prescription order date. RESULTS:The overall first-fill adherence rate for antidiabetic drugs was 85%. Copays < $10 (OR 2.22, 95% CI 1.57-3.14) and baseline A1c > 9% (OR 2.63, 95% CI 1.35, 5.09) were associated with improved firstfill rates while sex, age, and co-morbidity score had no association. A1c levels decreased among both filling and non-filling patients though significantly greater reductions were observed among filling patients. Biguanides and sulfonylureas had higher first-fill rates than second-line oral agents or insulin.CONCLUSIONS: First-fill rates for diabetes medication have room for improvement. Several factors that predict non-filling are readily identifiable and should be considered as possible targets for interventions.