Physician reported adherence to immunosuppressants in renal transplant patients: Prevalence, agreement, and correlates

Pabst, S.; Bertram, Anna; Zimmermann, Tanja; Schiffer, Mario; Zwaan, Martina de

doi:10.1016/j.jpsychores.2015.09.001

Cited by 63 publications

(77 citation statements)

References 46 publications

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“…Similar studies (e.g., Lennerling et al 2012) using the same method for collecting data on self-reported adherence (BAASIS © ) also indicate timing deviation to be the main problem. Recent studies showed slightly higher (36.3%, Pabst et al 2015) or similar (23.7%, Schmid-Mohler et al 2010) non-adherence rates.…”

Section: Discussionmentioning

confidence: 90%

Prevalence and Modifiable Determinants of Non-Adherence in Adult Kidney Transplant Recipients in a German Sample

Reber

Morawa

Stößel

et al. 2016

Zeitschrift für Psychosomatische Medizin und Psychotherapie

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Zusammenfassung Prävalenz und modifizierbare Determinanten der Non-Adhärenz bei erwachsenen Nierentransplantatempfängern in einer deutschen StichprobeFragestellung: Das Ziel dieser Querschnittstudie war die Untersuchung der Prävalenz und der modifizierbaren Determinanten der Non-Adhärenz bei erwachsenen Nierentransplantatempfängern in der Nachsorge. SummaryObjectives: The aim of this cross-sectional study was to investigate the prevalence and the modifiable determinants of non-adherence in adult kidney transplant patients in follow-up care. Methods: In 74 patients at least six months post-transplant, self-reported adherence (Basel Assessment of Adherence to Immunosuppressive Medications Scale, BAASIS © ), subjective experience and attitudes after transplantation (Medication Experience Scale for Immunosuppressants, MESI), and depression and anxiety (Hospital Anxiety and Depression Scale, HADS-D) were assessed. Results: Non-adherence to any of the four BAASIS © items was 24.3%. For the sub-dimensions: dose taking, drug holidays, timing deviation more than two hours from prescribed time, and dose reduction, the non-adherence levels were 9.5%, 0%, 17.6% and 2.7%, respectively. Marital status, negative beliefs towards immunosuppressants, and prominent anxiety and depression were associated with non-adherence. Conclusions: Screening for adherence and its indicators is of substantial importance in communication with renal transplant recipients. After detecting non-adherence, supportive interventions can be offered to the patients.

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Section: Discussionmentioning

confidence: 90%

Prevalence and Modifiable Determinants of Non-Adherence in Adult Kidney Transplant Recipients in a German Sample

Reber

Morawa

Stößel

et al. 2016

Zeitschrift für Psychosomatische Medizin und Psychotherapie

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“…For example, in one cohort, physician-suspected non-adherence was low (9%) compared to non-adherence based off of self-report questionnaires (31–37%), both of which are subjective measures. 16,17 The MPR is an objective method of non-adherence detection that has been demonstrated to be associated with adverse health outcomes and can be used optimally within a closed healthcare system, such as the VA. 11,12,18,19 Based on frequency histograms, we used a cut point MPR of 80% as our indicator value for non-adherence. Because an MPR of 80% has been recognized consistently as a definition of non-adherence in prescription refill record analyses and is generally recognized as acceptable across all adherence measures in solid organ transplant, this appears to validate our results.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Health Care Appointment Non-Adherence on Graft Outcomes in Kidney Transplantation

Taber

Fleming

Fominaya³

et al. 2016

Am J Nephrol

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Background: Non-adherence to medication is a well-studied and known cause of late allograft loss, but it is difficult to measure and prospectively monitor. The aim of this study was to assess if appointment non-adherence was correlated with medication non-adherence and a predictor of graft outcomes. Methods: This was a longitudinal cohort study that used the National United States Renal Data System and veterans affairs health records data with time-to-event analyses conducted to assess the impact on graft and patient survival. Results: The number of transplants that were included in the analysis was 4,646 (3,656 with complete records); 14.6% of patients had an appointment no show rate of ≥12% (non-adherence). Appointment and medication non-adherence were highly correlated and both were significant independent predictors of outcomes. Those with appointment non-adherence had 1.5 times the risk of acute rejection (22.0 vs. 14.7%, p < 0.0001) and a 65% higher risk of graft loss (adjusted hazards ratio (aHR) 1.65, 95% CI 1.38-1.97, p < 0.0001). There was a significant interaction between appointment and medication non-adherence; those with appointment and medication non-adherence were at very high risk of graft loss (aHR 4.18, 95% CI 3.39-5.15, p < 0.0001), compared to those with only appointment non-adherence (aHR 1.39, 95% CI 0.97-2.01, p = 0.0766) or only medication non-adherence (aHR 2.44, 95% CI 2.11-2.81, p < 0.0001). Conclusion: These results demonstrate that non-adherence to health care appointments is a significant and independent risk factor for graft loss.

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“…Eventhough there is the risk of social desirability with patient-reported non-adherence assessment (as it is with all self-report variables), patient-reported non-adherence has been shown to be associated with rejection [1, 10–12] and graft loss [1, 2, 6, 11, 13]. However, some studies failed to prove this association [6, 14].…”

Section: Introductionmentioning

confidence: 99%

Patient-reported non-adherence and immunosuppressant trough levels are associated with rejection after renal transplantation

et al. 2017

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BackgroundDifferent measures of non-adherence to immunosuppressant (IS) medication have been found to be associated with rejection episodes after successful transplantation. The aim of the current study was to investigate whether graft rejection after renal transplantation is associated with patient-reported IS medication non-adherence and IS trough level variables (IS trough level variability and percentage of sub-therapeutic IS trough levels).MethodsPatient-reported non-adherence, IS trough level variability, percentage of sub-therapeutic IS trough levels, and acute biopsy-proven late allograft rejections were assessed in 267 adult renal transplant recipients who were ≥12 months post-transplantation.ResultsThe rate of rejection was 13.5%. IS trough level variability, percentage of sub-therapeutic IS trough levels as well as patient-reported non-adherence were all significantly and positively associated with rejection, but not with each other. Logistic regression analyses revealed that only the percentage of sub-therapeutic IS trough levels and age at transplantation remained significantly associated with rejection.ConclusionsParticularly, the percentage of sub-therapeutic IS trough levels is associated with acute rejections after kidney transplantation whereas IS trough level variability and patient-reported non-adherence seem to be of subordinate importance. Patient-reported non-adherence and IS trough level variables were not correlated; thus, non-adherence should always be measured in a multi-methodological approach. Further research concerning the best combination of non-adherence measures is needed.

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Physician reported adherence to immunosuppressants in renal transplant patients: Prevalence, agreement, and correlates

Cited by 63 publications

References 46 publications

Prevalence and Modifiable Determinants of Non-Adherence in Adult Kidney Transplant Recipients in a German Sample

Prevalence and Modifiable Determinants of Non-Adherence in Adult Kidney Transplant Recipients in a German Sample

The Impact of Health Care Appointment Non-Adherence on Graft Outcomes in Kidney Transplantation

Patient-reported non-adherence and immunosuppressant trough levels are associated with rejection after renal transplantation

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