Psychosocial predictors of medication adherence in pediatric heart and lung organ transplantation

Abstract

Few studies have identified the psychosocial characteristics of those children and their families associated with future non-adherence to immunosuppressive medications following a heart or lung transplant. UNOS data and medical records information were used to test the association between patient and family psychosocial characteristics and medication adherence. Medication adherence outcomes were obtained using the physician assessments in the UNOS data and measured through patient-level standard deviation scores of immunosuppressive medication blood levels. Complete data were collected on 105 pediatric heart and lung transplant recipients and their families. Multivariate, stepwise analyses were conducted with each adherence outcome. Physician reports of adherence were associated with age of the child at transplantation, parental education, two-parent families, significant psychosocial problems, and the pretransplant life support status of the child. The resulting model (χ =28.146, df=5, P<.001) explained approximately 39.5% of the variance in physician reports of adherence (Nagelkerke r =.395). Blood level standard deviation scores were predicted by age at transplant (F=5.624, P=.02, r =.05). Results point to the difficulties experienced by children and families when undergoing a heart or lung transplantation. Efforts to develop standardized and evidence-based pretransplant psychosocial assessments in pediatric populations are suggested, especially those surrounding familial risk factors.

Psychosocial predictors of medication non‐adherence in pediatric organ transplantation: A systematic review

“…Several studies in this review reported male patients to be at greater risk of poor adherence, yet other studies reported greater non‐adherence among older female children . Although this may suggest an interaction between age and gender when predicting non‐adherence, an equal number of studies found no relationship between gender and adherence …”

“…Compared to an age‐matched cohort of another 15 cases, patients with severe and fatal non‐adherence each were found to have significant family problems including histories of child abuse. Similarly, history of child abuse and involvement in child abuse allegations as a victim were associated with greater non‐adherence in heart and lung recipients …”

“…Studies which found differences in non‐adherence among racial and ethnicity groups consistently identified African American or minority patients and families as experiencing greater adherence difficulties . However, other studies reported no adherence differences by racial/ethnic groups . Two studies reported significant missing data from racial and ethnic minorities which made detection of differences by these groups difficult …”

“…Patient age and gender have been the most widely studied predictors of post‐transplant adherence. In this review, 17 studies of 32 studies (53.1%) tested the association between age and adherence, with older patients, especially adolescents, found increasingly non‐adherent . A study of 2030 pediatric heart transplant patients found an association between adolescence and medication non‐adherence .…”

“…A recent membership survey of the Society for Transplant Social Workers found that over 70% of transplant social workers in pediatrics report not using a standardized psychosocial assessment . Furthermore, the standardized assessments used by a minority of respondents have very limited or untested psychometric validity and reliability …”