Investigating barriers to immunosuppressant medication adherence in renal transplant patients

Cossart, Amelia R.; Staatz, C. E.; Campbell, Scott; Isbel, Nicole M.; Cottrell, Neil

doi:10.1111/nep.13214

Cited by 41 publications

(44 citation statements)

References 31 publications

(104 reference statements)

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“…As other reports also have shown , the majority of these NoAd patients took all the prescribed doses but had a time deviation (22%). A 2‐h time deviation as the BAASIS © form defines as nonadherence may seem rigid and its clinical relevance in RTxR has been questioned . Recent pharmacokinetic simulation data indicate that ±4 h may be more relevant .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of tools for annual capture of adherence to immunosuppressive medications after renal transplantation - a single-centre open prospective trial

et al. 2019

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Summary Annual assessment of adherence would strengthen long‐term outcome assessments from registry data. The objective of this study was to evaluate tools suitable for annual routine capture of adherence data in renal transplant recipients. A single‐centre open prospective trial included 295 renal transplant recipients on tacrolimus. Two‐thirds of the patients were included 4 weeks post‐transplant, randomized 1:1 to intensive or single‐point adherence assessment in the early phase and 1‐year post‐transplant. One‐third were included 1‐year post‐transplant during a cross‐sectional investigation. Adherence was assessed using multiple methods: The “Basel Assessment of Adherence to Immunosuppressive Medication Scale” (BAASIS©) questionnaire was used to assess self‐reported adherence. The treating clinician scored patient′s adherence and tacrolimus trough‐concentration variability was calculated. In the analyses, the data from the different tools were dichotomized (adherent/nonadherent). The BAASIS© overall response rate was over 80%. Intensive BAASIS© assessment early after transplantation increased the chance of capturing a nonadherence event, but did not influence the 1‐year adherence prevalence. The adherence tools generally captured different populations. Combining the tools, the nonadherence prevalence at 1 year was 38%. The different tools identified to a large degree different patients as nonadherent. Combining these tools is feasible for annual capture of adherence status.

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Section: Discussionmentioning

confidence: 99%

Evaluation of tools for annual capture of adherence to immunosuppressive medications after renal transplantation - a single-centre open prospective trial

et al. 2019

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“…RTX patients reported higher necessity of medicines than while in dialysis. The Necessity‐concern differential, which is found to be correlated with adherence, increased markedly. One reason for this increase may be that the patients are thoroughly informed and trained about the use and necessity of immunosuppressants after RTX.…”

Section: Discussionmentioning

confidence: 97%

“…Depressive symptoms were associated with high scores in the subscales Harm, Overuse, and Concern. Some studies have found that depression may be linked to a low Necessity‐concern differential, meaning that the patients’ concerns about their medications surpass the expected necessity of them . The same studies showed that this may be an important barrier to adherence, while others have not found similar associations .…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have found that depression may be linked to a low Necessity‐concern differential, meaning that the patients’ concerns about their medications surpass the expected necessity of them . The same studies showed that this may be an important barrier to adherence, while others have not found similar associations . Depression is a known predictor of both graft loss and mortality in ESRD patients, but the cause of these associations are not known.…”

Section: Discussionmentioning

confidence: 99%

“…ESRD patients have the highest daily pill burden in patients with chronic diseases, with an average of 12‐19 pills per day . Adherence is important to alleviate disturbing symptoms, prevent graft rejection in renal transplanted patients (RTX) and to prolong survival . However, adherence may be especially challenging in complicated treatment regimens with a heavy pill burden …”

Section: Introductionmentioning

confidence: 99%

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Beliefs about medicines in dialysis patients and after renal transplantation

Drangsholt

Cappelen

Lippe

et al. 2019

Hemodialysis International

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Introduction: Patients with end‐stage renal disease are burdened by a complex medication regimen, but little is known about the belief about medicine among dialysis‐ and renal transplant (RTX) patients. Patients’ beliefs about medicines may influence drug adherence and thereby affect morbidity and mortality. The aim of the present study was to assess the beliefs about medicine in dialysis as well as after RTX. Methods: In a prospective study, 301 dialysis patients were followed for up to 5.5 years during which time 142 had been transplanted. Out of the transplanted patients, 110 were eligible for inclusion. The Beliefs about Medicine Questionnaire (BMQ) was used to assess the beliefs in dialysis and after transplantation. BMQ in dialysis was also compared to that of the general Norwegian population (n = 426). Multiple linear regression analyses were performed with BMQ subscales as dependent variables and sociodemographic and clinical data as independent variables. Findings: Median age in dialysis was 62 (IQR 50‐73) years, 66.1% were male and 80.7% were treated with hemodialysis. When in dialysis, 98.2% strongly believed their medications were necessary, while 34.4% reported strong concerns. Furthermore, 17.3% believed their medications to be harmful and 38.6% believed that doctors overprescribed medicines. The Necessity‐concern differential had a positive score in 92.6% of the patients. Follow‐up time was 55 (IQR 50‐59) months. After transplantation, there was an increase in the patient‐reported necessity of medication (21.9 ± 2.7 vs. 23.8 ± 1.9, P < 0.001) compared to while in dialysis. Correlations were found between patient beliefs and education, age, and depression. Discussion: Although positive beliefs about medicines increase after transplantation, concerns are high in both dialysis and after RTX. Implementing the BMQ routinely in the clinical evaluation of dialysis‐ and RTX patients may help to identify patients with increased risk for medical nonadherence.

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Mirabegron has longer treatment persistence than antimuscarinics: Real‐world data from a Korean national cohort database

Lee

Park

Kang

et al. 2021

Neurourology and Urodynamics

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Aims: To descriptively evaluate treatment persistence among adults who received mirabegron or antimuscarinics in South Korea. Methods: This study involved a retrospective analysis of the Health Insurance Review and Assessment (HIRA) database. Patients (≥18 years) who had a new prescription for an overactive bladder (OAB) target medication (mirabegron/ antimuscarinic) within an 8-month index period (July 1, 2015-February 29, 2016) were included. The date when the target (index) medication was dispensed was the index date. The 6-month period before the index date was used to assess patient eligibility. A 12-month post-index period was used to assess medication persistence, which was defined as the time to discontinuation.Overall data were analyzed and the results were also stratified by age group (≤65, >65 years), sex, or prior OAB medication experience. Persistence rates were calculated after the 1st, 3rd, 6th, 9th, and 12th months.Results: A data set of 52 722 cases was obtained (mirabegron: 11 424, antimuscarinics: 41 298). The mean age was 60.9 ± 16.1 years and the majority of the patients were female (30 862 [58.5%] patients). Median persistence was longer with mirabegron (51 days) versus antimuscarinics (25 days). The persistence rate with mirabegron was higher throughout the study compared with all the antimuscarinics (12-month data: 13.5% and 4.9%, respectively). Longer treatment persistence was noted in older, male, and treatment-experienced patients. Conclusion:The results from the HIRA database showed that persistence was longer with mirabegron than with antimuscarinics in South Korea. This finding may help inform clinical decision-making within the South Korean healthcare system.

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Investigating barriers to immunosuppressant medication adherence in renal transplant patients

Abstract: Over half the patients self-reported non-adherence. The main modifiable barriers leading to non-adherence were forgetfulness and skipped doses. Personalised interventions focused on habit forming may improve adherence in this population.

Cited by 41 publications

References 31 publications

Evaluation of tools for annual capture of adherence to immunosuppressive medications after renal transplantation - a single-centre open prospective trial

Evaluation of tools for annual capture of adherence to immunosuppressive medications after renal transplantation - a single-centre open prospective trial

Beliefs about medicines in dialysis patients and after renal transplantation

Mirabegron has longer treatment persistence than antimuscarinics: Real‐world data from a Korean national cohort database

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