Prevalence of Medication Nonadherence to Co-medication Compared to Immunosuppressants in Heart Transplant Recipients: Findings From the International Cross-sectional BRIGHT Study

Helmy, Remon; Denhaerynck, Kris; Berben, Lut; Dobbels, Fabienne; Russell, Cynthia L.; Roza, Bartira de Aguiar; Geest, Sabina De; Crespo-Leiro, María G.; Cupples, Sandra; Simone, Paolo De; Groenewoud, Albert; Kugler, Christiane; Ohler, Linda; Cleemput, Johan Van; Poncelet, Alain; Sebbag, Laurent; Michel, Magali; Bernard, Andrée; Doesch, Andreas O.; Livi, Ugolino; Potena, Luciano; Brossa-Loidi, Vicens; Segovia‐Cubero, Javier; Almenar‐Bonet, Luis; Saint-Gerons, C. Segura; Mohaçsi, Paul; Horváth, Éva; Riotto, Cheryl; Parry, Gareth; Firouzi, Ashi; Kozuszko, Stella; Haddad, Haissam; Kaan, Annemarie; Fisher, Grant; Miller, Tara; Flattery, Maureen; Ludrosky, Kristin; Albert, Nancy; Coleman, Bernice; Trammell, Jacqueline; Epstein, Flavio; Clair, Katherine St.; Kao, Andrew; Molina, María; Canales, Karyn Ryan; Almeida, Samira Scalso de; Ayoub, Andrea Cotait; Barone, Fernanda; Harkess, M.; Maddicks-Law, J.

doi:10.1016/j.clinthera.2018.11.007

Cited by 11 publications

(9 citation statements)

References 12 publications

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“…The BAASIS is reliable, valid, short, simple to use, and sensitive to the taking and timing of immunosuppressive drugs 22 . It has been previously used to evaluate nonadherence to immunosuppressive medication among heart, liver, and lung transplant recipients 23–26 . Its score is reliable, as shown by its total Cronbach alpha coefficient of .697 26 …”

Section: Resultsmentioning

confidence: 99%

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Implementation of patient‐reported outcome measures in a heart transplant recipient registry: First step toward a patient‐centered approach

Mahmoudi

Moitie

Dorent

et al. 2022

Clinical Transplantation

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Background: Heart transplantation (HTX) is a well-established treatment for suitable patients with end-stage heart failure, intended to prolong their survival and improve their health-related quality of life (HR-QoL). No international consensus exists, however, about the preferred patient-reported outcomes (PROs) and their measures (PROMs) for heart transplant recipients. The purpose of this study, the first step in a mixed-method investigation, was to review the PROMs developed and used in this population to identify the instruments for measuring HR-QoL and adherence to immunosuppressive medications most appropriate for heart transplant patients.Methods: This systematic search of the literature in the PubMed database focused on the assessment of PROMs for patients after HTX. We analyzed 66 studies with cross-sectional, 28 with longitudinal, and 2 with mixed-methods designs, as well as 6 literature reviews.Results: These 102 articles used 115 different PROMs, which we categorized as generic HR-QoL instruments (n = 19), domain-specific instruments (n = 71), heart disease-specific instruments (n = 9), and heart transplant-specific instruments (n = 16).They cover different dimensions of HR-QoL and of immunosuppressive-drug experience, with diverse numbers of items, types of scales, and psychometric properties.Conclusions: Despite the abundance of instruments, PROMs for HTX can be improved to meet other patient expectations (i.e., by including important issues such as coping strategies, employment, social support, sexual relationships, spirituality, and beliefs), while paying attention to ease of use, reliability, validity, and the contribution of new technologies. A qualitative approach will complete our project of developing a patientcentered instrument for HTX patients.

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Section: Resultsmentioning

confidence: 99%

“…22 It has been previously used to evaluate nonadherence to immunosuppressive medication among heart, liver, and lung transplant recipients. [23][24][25][26] Its score is reliable, as shown by its total Cronbach alpha coefficient of .697. 26…”

Section: Basel Assessment Of Adherence To Immunosuppressive Medicatio...mentioning

confidence: 99%

Implementation of patient‐reported outcome measures in a heart transplant recipient registry: First step toward a patient‐centered approach

Mahmoudi

Moitie

Dorent

et al. 2022

Clinical Transplantation

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“…Heart transplantation is the gold-standard treatment for refractory end-stage heart failure 1. Heart transplant recipients require numerous medications with complex treatment regimens, including immunosuppressants 2,3. Life-long immunosuppression is often critical for solid organ recipients to prevent graft rejection from an immune response 4,5.…”

Section: Introductionmentioning

confidence: 99%

“…Near-perfect adherence to immunosuppressants is crucial to achieving optimal long-term graft survival 2,6. However, many studies have revealed that immunosuppressant nonadherence (INA) has become a persistent problem among solid organ recipients 3,7…”

Section: Introductionmentioning

confidence: 99%

<p>Prevalence and Risk Factors of Immunosuppressant Nonadherence in Heart Transplant Recipients: A Single-Center Cross-Sectional Study</p>

Zhang¹,

Zhou²,

Nelson³

et al. 2019

PPA

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BackgroundImmunosuppressant nonadherence (INA) has been shown to affect outcomes after solid organ transplantation. The aim of the present study was to determine the prevalence of INA in heart transplant recipients and the associated risk factors of INA.MethodsAdult heart transplant recipients who firstly received heart transplantation (discharged for at least 3 months) were consecutively enrolled. Immunosuppressant adherence was assessed using the Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS). INA was categorized into five domains of contributing factors (socio-demographic factors, transplant-related factors, healthcare system access factors, post-transplant treatment-related factors, and patient-related psychosocial factors). These factors were compared between adherent and nonadherent patients. The risk factors of INA were investigated by logistic regression analysis.ResultsA total of 168 heart recipients were ultimately included. Among them, 69 (41.1%) recipients were revealed to be nonadherent. Logistic regression analysis indicated that INA was associated with monthly income<3000 Chinese Yuan (CNY) (OR, 3.11; 95% CI, 1.58–6.12; p=0.001), number of prescribed concomitant drugs (OR, 1.23; 95% CI, 1.12–1.50; p=0.003) and concerns about immunosuppressants (OR, 1.09; 95% CI, 1.01–1.18; p=0.031).ConclusionsHeart recipients had a high prevalence of INA. Lower income, greater number of prescribed concomitant drugs, and more concerns about immunosuppressants correlated most with timing nonadherence and taking nonadherence among heart recipients. These findings will be helpful to intervene on and prevent future INA of heart recipients.

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“…Cost-related medication nonadherence (CRMNA) consists of 3 behaviors, namely, not filling a prescription and skipping or reducing doses because of their cost, 9 and is a distinct concept from medication nonadherence as defined by the ABC taxonomy 10 (the prevalence and determinants of the latter have previously been reported as part of the BRIGHT study). 11 , 12 The 2014 Commonwealth Fund International Health Policy Survey of Older Adults assessed CRMNA, defined as either not filling a prescription or skipping doses within the last 12 months because of out-of-pocket (OOP) costs. 13 The lowest nonadherence rates occurred in France, Norway, Sweden, Switzerland, and the United Kingdom (<3%); the highest were observed in the United States (16.8%), Canada (8.3%), and Australia (6.8%).…”

mentioning

confidence: 99%

Prevalence and Correlates of Cost-Related Medication Nonadherence to Immunosuppressive Drugs After Heart Transplantation

et al. 2020

Self Cite

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Background Cost-related medication nonadherence (CRMNA) refers to not taking medications as prescribed because of difficulties paying for them. Objectives The aims of this study were (1) to assess the prevalence of CRMNA to immunosuppressants in heart transplant recipients internationally and (2) to determine multilevel correlates (patient, center, and healthcare system levels) of CRMNA. Methods Using data from the cross-sectional international BRIGHT study, applying multistaged sampling, CRMNA was assessed via 3 self-report items in 1365 patients from 36 heart transplant centers in 11 countries. Cost-related medication nonadherence was defined as any positive answer on any of the 3 items. Healthcare system–level (ie, insurance coverage, out-of-pocket expenditures) and patient-level (ie, intention, perceived financial burden, cost as a barrier, a health belief regarding medication benefits, cost-related self-efficacy, and demographic factors) CRMNA correlates were assessed. Correlates were examined using mixed logistic regression analysis. Results Across all study countries, CRMNA had an average prevalence of 2.6% (range, 0% [Switzerland/Brazil] to 9.8% [Australia]) and was positively related to being single (odds ratio, 2.29; 95% confidence interval, 1.17–4.47), perceived financial burden (odds ratio, 2.15; 95% confidence interval, 1.55–2.99), and cost as a barrier (odds ratio, 2.60; 95% confidence interval, 1.66–4.07). Four protective factors were identified: white ethnicity (odds ratio, 0.37; 95% confidence interval, 0.19–0.74), intention to adhere (odds ratio, 0.44; 95% confidence interval, 0.31–0.63), self-efficacy (odds ratio, 0.54; 95% confidence interval, 0.43–0.67), and belief about medication benefit (odds ratio, 0.70; 95% confidence interval, 0.57–0.87). Regarding variability, 81.3% was explained at the patient level; 13.8%, at the center level; and 4.8%, at the country level. Conclusion In heart transplant recipients, the CRMNA prevalence varies across countries but is lower than in other chronically ill populations. Identified patient-level correlates are novel (ie, intention to adhere, cost-related barriers, and cost-related self-efficacy) and indicate patient-perceived medication cost burden.

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Prevalence of Medication Nonadherence to Co-medication Compared to Immunosuppressants in Heart Transplant Recipients: Findings From the International Cross-sectional BRIGHT Study

Cited by 11 publications

References 12 publications

Implementation of patient‐reported outcome measures in a heart transplant recipient registry: First step toward a patient‐centered approach

Implementation of patient‐reported outcome measures in a heart transplant recipient registry: First step toward a patient‐centered approach

<p>Prevalence and Risk Factors of Immunosuppressant Nonadherence in Heart Transplant Recipients: A Single-Center Cross-Sectional Study</p>

Prevalence and Correlates of Cost-Related Medication Nonadherence to Immunosuppressive Drugs After Heart Transplantation

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