Perceived barriers to adherence among adolescent renal transplant candidates

Abstract

Non-adherence to medical regimens is a ubiquitous hindrance to quality health care among adolescent transplant recipients. Identification of potentially modifiable barriers to adherence when patients are listed for organ transplant would help with early intervention efforts to prepare adolescents for the stringent medication regimen post-transplant. Fifty-six adolescents listed for a kidney transplant, mean age 14.27 (s.d. = 2.2; range 11-18 yr), 73.2% male, 62.5% Caucasian participated in a semi-structured interview, the Medical Adherence Measure, to assesses the patient's knowledge of the prescribed regimen, reported adherence (missed and late doses), the system used to organized medications, and who holds the primary responsibility over medication management. Better knowledge of the medication regimen was associated with fewer missed doses (r = -0.48, p < 0.001). Patients who perceived more barriers had more missed (r = 0.38, p = 0.004) and late (r = 0.47, p < 0.001) doses. Patients who endorsed "just forget," the most common barrier (56.4%), reported significantly more missed (z = -4.25, p < 0.001) and late (z = -2.2, p = 0.02) doses. Only one-third of the transplant candidates used a pillbox to organize medications but these patients had significantly better adherence, z = -2.2, p = 0.03. With regard to responsibility over managing the regimens, adolescents missed fewer doses when their parents were in charge than when they were solely responsible, z = -2.1, p = 0.04. Interventions developed to prepare transplant candidates for a stringent post-transplant regimen need to focus on ensuring accurate knowledge of as simple a regimen as possible. Use of an organized system such as a pillbox to establish a routine and facilitate tracking of medications is recommended with integration of reminders that may be appealing for this age group. Although individuation is developmentally normative at this age, parent involvement seems critical until the adolescent is able to manage the responsibility more independently.

Medication beliefs and perceived barriers in adolescent renal transplant patients and their parents

“…Children with chronic illnesses such as asthma, human immunodeficiency virus, inflammatory bowel disease, and organ transplantation, as well as their parents, have reported various barriers to medication adherence [12][13][14][15][16][17][18][19]. The most common barriers identified across pediatric chronic illnesses include cognitive factors (forgetting, difficulty with the complex regimen, time management) and life-style adaptation (being away from home, interference with an activity, changes in routine) [12][13][14][15][16][17][18][19].…”

“…The most common barriers identified across pediatric chronic illnesses include cognitive factors (forgetting, difficulty with the complex regimen, time management) and life-style adaptation (being away from home, interference with an activity, changes in routine) [12][13][14][15][16][17][18][19]. Additionally, psychological factors (lack of self-efficacy, denial, distrust, behavioral defiance), social factors (lack of social support, peer pressures), and family issues (conflict between parents and children) also play a major role in poor adherence [13][14][15].…”

A single high dose of ergocalciferol can be used to boost 25-hydroxyvitamin D levels in children with kidney disease

“…It is well known that adherence to treatment is a major problem in children with kidney disease, particularly among adolescents [4]. Because there have been previous problems with significant non-adherence to prescribed therapy, we have recently changed our practice regarding the administration of ergocalciferol to vitamin D-deficient patients.…”

“…Of the children attending our outpatient clinics, 58% were vitamin D deficient/insufficient, defined as 25(OH)D3 levels of less than 20 ng/ml. A total of 83.2% had levels below 30 ng/ml, a value very similar to that reported in the study by Menon and colleagues, indicating the high prevalence of this problem on both sides of the Atlantic.It is well known that adherence to treatment is a major problem in children with kidney disease, particularly among adolescents [4]. Because there have been previous problems with significant non-adherence to prescribed therapy, we have recently changed our practice regarding the administration of ergocalciferol to vitamin D-deficient patients.…”

Cumplimiento del tratamiento en el trasplante renal pediátrico

“…En un estudio de Feinstein encuentran una elevada prevalencia de incumplimiento en adolescentes que se administran solos las medicación 5 . También se ha descrito una adherencia signifi cativamente mejor en los pacientes que tienen mayor conocimiento del régimen terapéutico, que sus padres o cuidadores son responsables del tratamiento y los que usan pastilleros unidosis para organizar la medicación 6 . La implicación de las familias en nuestro estudio justifi ca el buen manejo del tratamiento, ya que el paciente por su edad no se responsabiliza de dicho tratamiento ni de la constancia del mismo (74% tomaba la medicación acompañado y el 26% solos).…”