Renal Transplant Patient Compliance With Free Immunosuppressive Medications.

Chisholm, Marie A.; Vollenweider, Leslie J.; Mulloy, Laura L.; Wynn, James J.; Jagadeesan, Muralidharan; DiPiro, Joseph T.

doi:10.1097/00007890-200004271-00591

Cited by 55 publications

(99 citation statements)

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“…Previous studies suggest biological, affective, cognitive, behavioral and environmental factors may impact health behaviors and act as causes of nonadherence (10)(11)(12)(13)(14). Such findings are consistent with the tenets of social cognitive theory, which postulates that behavior is influenced by environmental and personal (biological, affective and cognitive) factors and aspects of the behavior itself (15)(16)(17).…”

Section: Introductionsupporting

confidence: 78%

“…Limitations of pharmacy refill records include that their accuracy may be affected by dosage changes and that they do not indicate whether medication is actually consumed according to the prescribed dosing schedule (43)(44)(45). However, as previously stated, prior research has found that RTRs who appropriately refill their IST are more likely to have desired IST serum concentrations, and therefore we believe pharmacy refill records are a reliable and valid measure of IST adherence (12). Another limitation is that we were unable to collect utilization and cost data directly, as our sample had multiple payers and sought healthcare services from a wide range of providers and institutions across multiple states.…”

Section: Discussionmentioning

confidence: 84%

“…Pharmacy refill records were used to measure IST adherence since they are an objective measure of the quantity of medication dispensed, are highly correlated with electronic medication monitoring, and have been used successfully in other medication adherence studies, demonstrating significant associations with health outcomes (34)(35)(36)(37). Additionally, research has indicated that RTRs who get their IST refills filled appropriately are more likely to have desired IST serum concentrations, indicating that RTRs took their IST (12). Refill records were obtained from Avella and assessed at baseline (after informed consent was obtained; baseline adherence was calculated using refill records data for the 1-year period prior to enrollment), 3, 6, 9 and 12 months.…”

Section: Outcome Measuresmentioning

confidence: 99%

See 2 more Smart Citations

Improving Outcomes of Renal Transplant Recipients With Behavioral Adherence Contracts: A Randomized Controlled Trial

Chisholm-Burns

Spivey

Zivin

et al. 2013

American Journal of Transplantation

103

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The objective of this randomized controlled trial was to assess the effects of a 1-year behavioral contract intervention on immunosuppressant therapy (IST) adherence and healthcare utilizations and costs among adult renal transplant recipients (RTRs). The sample included adult RTRs who were at least 1 year posttransplant, taking tacrolimus or cyclosporine and served by a specialty pharmacy. Pharmacy refill records were used to measure adherence and monthly questionnaires were used to measure healthcare utilizations. Direct medical costs were estimated using the 2009 Medicare Expenditure Panel Survey. Adherence was analyzed using the GLM procedure and the MIXED procedure of SAS. Rate ratios and 95% confidence intervals were estimated to quantify the rate of utilizing healthcare services relative to treatment assignment. One hundred fifty RTRs were enrolled in the study. Intervention group RTRs (n ¼ 76) had higher adherence than control group RTRs (n ¼ 74) over the study period (p < 0.01). And 76.1% of the intervention group compared with 42.7% of the control group was not hospitalized during the 1-year study period (RR ¼ 1.785; 95% CI: 1.314, 2.425), resulting in cost savings. Thus, evidence supports using behavioral contracts as an effective adherence intervention that may improve healthcare outcomes and lower costs.

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Section: Introductionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 84%

Section: Outcome Measuresmentioning

confidence: 99%

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Improving Outcomes of Renal Transplant Recipients With Behavioral Adherence Contracts: A Randomized Controlled Trial

Chisholm-Burns

Spivey

Zivin

et al. 2013

American Journal of Transplantation

103

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“…2,6 Time after transplant also may be a factor, where generally, adherence to immunosuppressants seems to decrease, as time after the transplant increases. 1,2,6,11,14,16 This is supported by a study of kidney recipients in which all study participants received their immunosuppressants for free for 12 months; adherence to immunosuppressants declined after 9 months, despite removing cost as a factor. 14 Age is a factor in assessing NA in organ recipients.…”

Section: Figure 2 Medication Possession Ratios For Overall and Indivmentioning

confidence: 95%

“…[13][14] Medication possession ratio for each recipient was calculated individually for each immunosuppressant medication and then averaged, to obtain the overall MPR. Suboptimal adherence was defined as a MPR < 80%.…”

Section: Definitionsmentioning

confidence: 99%

Assessing Medication Adherence in Solid-Organ Transplant Recipients

Greanya²,

Partovi³

et al. 2013

Exp Clin Transplant

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Objectives: We sought to determine and compare the prevalence of nonadherence in lung, kidney, and liver transplant recipients, and identify potential risk factors for nonadherence. Materials and Methods: This cross-sectional, singlecenter, retrospective cohort study, evaluated 225 outpatient lung, kidney, and liver transplant recipients' adherence to immunosuppressant medication. Based on immunosuppressant dosages and dispensing records, medication possession ratio (days of medication supplied/actual days) and gaps in prescription refills (> 30-day lapse between expected depletion of supply and next refill) were used as surrogate markers in assessing adherence for 2 years. Patients were adherent to their immunosuppressant medication regimens if their medication possession ratio was ≥ 80%. Results: The mean age of the subjects was slightly greater than 50 years of age, and they were a median of 2.0, 1.3, and 1.1 years posttransplant at the start of data collection for lung, kidney, and liver recipients. Overall medication possession ratios were 95.4% ± 7.5%, 95.9% ± 7.6%, and 92.7% ± 12.3% in our lung, kidney, and liver recipients. Only 7.1% of patients had a medication possession ratio lower than 80%, which was the cutoff for nonadherence.No statistical analyses were performed to identify potential factors for nonadherence because of the small number of nonadherent patients. Conclusions: Immunosuppressant medication adherence at our center was high for all 3 organ cohorts, as measured by a medication possession ratio of 80% or better. Further study is needed to evaluate immunosuppressant adherence over time after transplant, and confirm the clinical factors that optimize adherence in high-risk patients.

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Medication adherence patterns in adult renal transplant recipients

et al. 2006

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Patient adherence to immunosuppressive medications adherence is crucial to survival of the patient and a transplanted kidney, yet adherence is variable. Using a prospective, descriptive design, immunosuppressive medication adherence of 44 renal transplant recipients was followed for 6 months at a Midwestern transplant center using electronic monitoring. Four medication adherence patterns emerged from a hierarchical cluster analysis: those who took medications on time, those who took medications on time with late/missed doses, those who rarely took medications on time and who were late with morning and/or evening doses, and those who missed doses. This study is a step toward developing and implementing interventions targeted to specific patterns of poor adherence.

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Renal Transplant Patient Compliance With Free Immunosuppressive Medications.

Cited by 55 publications

References 0 publications

Improving Outcomes of Renal Transplant Recipients With Behavioral Adherence Contracts: A Randomized Controlled Trial

Improving Outcomes of Renal Transplant Recipients With Behavioral Adherence Contracts: A Randomized Controlled Trial

Assessing Medication Adherence in Solid-Organ Transplant Recipients

Medication adherence patterns in adult renal transplant recipients

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