Medication Adherence After Renal Transplantation—a Review of the Literature

Rebafka, Anne

doi:10.1111/jorc.12181

Cited by 31 publications

(36 citation statements)

References 76 publications

(401 reference statements)

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“…16 Factors that underlying their decisions vary from experiencing adverse effects 17 to their perceptions of the need for the prescribed treatment. 18 The concept of intentionality has been used to examine treatment nonadherence among individuals living with a variety of chronic conditions, including coronary heart disease, [19][20][21] glaucoma, 22 kidney disease, 23 hypertension, 20,24 epilepsy, 25 and diabetes. 21,24 This research has led to tailored interventions, with mixed results, and recommendations that focus on intentional and unintentional nonadherence.…”

Section: Introductionmentioning

confidence: 99%

Intentional and unintentional nonadherence to hydroxyurea among people with sickle cell disease: a qualitative study

et al. 2020

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Hydroxyurea is an efficacious treatment for sickle cell disease (SCD), but adoption is low among individuals with SCD. The objective of this study was to examine barriers to patients’ adherence to hydroxyurea use regimens by using the intentional and unintentional medication nonadherence framework. We interviewed individuals with SCD age 15 to 49.9 years who were participants in the Sickle Cell Disease Implementation Consortium (SCDIC) Needs Assessment. The intentional and unintentional medication nonadherence framework explains barriers to using hydroxyurea and adds granularity to the understanding of medication adherence barriers unique to the SCD population. In total, 90 semi-structured interviews were completed across 5 of the 8 SCDIC sites. Among interviewed participants, 57.8% (n = 52) were currently taking hydroxyurea, 28.9% (n = 26) were former hydroxyurea users at the time of the interview, and 13.3% (n = 12) had never used hydroxyurea but were familiar with the medication. Using a constructivist grounded theory approach, we discovered important themes that contributed to nonadherence to hydroxyurea, which were categorized under unintentional (eg, Forgetfulness, External Influencers) and intentional (Negative Perceptions of Hydroxyurea, Aversion to Taking Any Medications) nonadherence types. Participants more frequently endorsed adherence barriers that fell into the unintentional nonadherence type (70%) vs intentional nonadherence type (30%). Results from this study will help SCD health care providers understand patient choices and decisions as being either unintentional or intentional, guide tailored clinical discussions regarding hydroxyurea therapy, and develop specific, more nuanced interventions to address nonadherence factors.

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Section: Introductionmentioning

confidence: 99%

Intentional and unintentional nonadherence to hydroxyurea among people with sickle cell disease: a qualitative study

et al. 2020

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“…To date, little is known about haemodialysis patients’ perceptions regarding their prescribed regimen and the factors influencing their medication-taking behaviour. Understanding patients’ perspectives can help identify potentially modifiable factors such as patients’ intention to adhere, beliefs about medicines, features about treatment regimens, experiences of side effects, and provision of support mechanism required to facilitate adherence [17]. As such, we aimed to qualitatively explore factors associated with medication adherence, and examine the differential perspectives on medication-taking behaviour shown by haemodialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Medication adherence perspectives in haemodialysis patients: a qualitative study

et al. 2017

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BackgroundEnd-stage kidney disease patients undergoing haemodialysis are prescribed with multiple complex regimens and are predisposed to high risk of medication nonadherence. The aims of this study were to explore factors associated with medication adherence, and, to examine the differential perspectives on medication-taking behaviour shown by adherent and nonadherent haemodialysis patients.MethodsA qualitative exploratory design was used. One-on-one semi-structured interviews were conducted with 30 haemodialysis patients at the outpatient dialysis facility in Hobart, Australia. Patient self-reported adherence was measured using 4-item Morisky Green Levine scale. Interview transcripts were thematically analysed and mapped against the World Health Organization (WHO) determinants of medication adherence.ResultsParticipants were 44–84 years old, and were prescribed with 4–19 medications daily. More than half of the participants were nonadherent to their medications based on self-reported measure (56.7%, n = 17). Themes mapped against WHO adherence model comprised of patient-related (knowledge, awareness, attitude, self-efficacy, action control, and facilitation); health system/ healthcare team related (quality of interaction, and mistrust and collateral arrangements); therapy-related (physical characteristics of medicines, packaging, and side effects); condition-related (symptom severity); and social/ economic factors (access to medicines, and relative affordability).ConclusionsPatients expressed a number of concerns that led to nonadherence behaviour. Many of the issues identified were patient-related and potentially modifiable by using psycho-educational or cognitive-behavioural interventions. Healthcare professionals should be more vigilant towards identifying these concerns to address adherence issues. Future research should be aimed at understanding healthcare professionals’ perceptions and practices of assessing medication adherence in dialysis patients that may guide intervention to resolve this significant issue of medication nonadherence.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-017-0583-9) contains supplementary material, which is available to authorized users.

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“…Reasons for non-adherence vary between age groups and include side-effect profiles, perceived harm, changes to physical appearance and psychological distress. At all clinic visits, non-adherence should be considered and discussed with patients and their family, ideally by the specialist pharmacist 23…”

Section: How Should Immunosuppression Be Managed In the Clinic?mentioning

confidence: 99%

“…At all clinic visits, non-adherence should be considered and discussed with patients and their family, ideally by the specialist pharmacist. 23 …”

Section: How Should Immunosuppression Be Managed In the Clinic?mentioning

confidence: 99%

Adult liver transplantation: UK clinical guideline - part 2: surgery and post-operation

Millson

Considine

Cramp

et al. 2020

Frontline Gastroenterol

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Survival rates for patients following liver transplantation exceed 90% at 12 months and approach 70% at 10 years. Part 1 of this guideline has dealt with all aspects of liver transplantation up to the point of placement on the waiting list. Part 2 explains the organ allocation process, organ donation and organ type and how this influences the choice of recipient. After organ allocation, the transplant surgery and the critical early post-operative period are, of necessity, confined to the liver transplant unit. However, patients will eventually return to their referring secondary care centre with a requirement for ongoing supervision. Part 2 of this guideline concerns three key areas of post liver transplantation care for the non-transplant specialist: (1) overseeing immunosuppression, including interactions and adherence; (2) the transplanted organ and how to initiate investigation of organ dysfunction; and (3) careful oversight of other organ systems, including optimising renal function, cardiovascular health and the psychosocial impact. The crucial significance of this holistic approach becomes more obvious as time passes from the transplant, when patients should expect the responsibility for managing the increasing number of non-liver consequences to lie with primary and secondary care.

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Medication Adherence After Renal Transplantation—a Review of the Literature

Cited by 31 publications

References 76 publications

Intentional and unintentional nonadherence to hydroxyurea among people with sickle cell disease: a qualitative study

Intentional and unintentional nonadherence to hydroxyurea among people with sickle cell disease: a qualitative study

Medication adherence perspectives in haemodialysis patients: a qualitative study

Adult liver transplantation: UK clinical guideline - part 2: surgery and post-operation

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