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Zhao Q, Dong L, Wang L, Zhao H, Zhu X, Zhang Z, Liu J. Immunosuppressant medication behaviours in solid organ transplant recipients: a cross-sectional study from south-central China during COVID-19 reopening period. BMJ Open 2024; 14:e080998. [PMID: 38448078 PMCID: PMC10916083 DOI: 10.1136/bmjopen-2023-080998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE Medication non-adherence to immunosuppressants threatens allograft survival and function maintenance among solid organ transplant (SOT) recipients. This study aimed to investigate the prevalence of immunosuppressant medication non-adherence and associated factors during the COVID-19 reopening period among Chinese SOT recipients. DESIGN Cross-sectional study. SETTING South-central China. POPULATION Adult patients who received SOT with functioning graft. METHODS Sociodemographic questionnaire and scales to measure physical activity, depression and medication non-adherence were used to collect data. Logistic regression analysis was conducted to identify factors associated with medication non-adherence. Mediation and moderated mediation analyses were performed to examine the potential mechanisms influencing medication behaviour during the pandemic reopening period using SPSS PROCESS macro 4.3 software. RESULTS A total of 1121 participants were recruited and the prevalence of medication non-adherence was 36.3% in this study. Recipients who were men, had a higher monthly income, lived alone, had received transplantation for a minimum of 3 years, had received COVID-19 vaccination and experienced depressive symptoms exhibited an increased risk of non-adherence. Contrarily, those who engaged in high-intensity physical activity exhibited a decreased risk. Physical activity was negatively associated with medication non-adherence (r=-0.124, p<0.001) with depression fully mediating this relationship (B=-0.014, 95% CI: -0.032 to -0.003). COVID-19 vaccination significantly moderated the relationship between physical activity and depression (B=-0.303, 95% CI: -0.515 to -0.090). CONCLUSION This study investigated the prevalence of medication non-adherence among SOT recipients during the COVID-19 reopening period in China, its associated factors and a potential mechanism. Depression fully mediated the association between physical activity and medication non-adherence, and COVID-19 vaccination moderated the relationship between physical activity and depression. These findings provide some insights for managing medication behaviour when confronting public health emergencies. However, relationships displayed in the moderated mediation model should be tracked after returning to normal life and other potential relationships should be explored to deeply understand medication non-adherent behaviour.
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Affiliation(s)
- Qin Zhao
- Central South University Xiangya School of Nursing, Changsha, Hunan, China
| | - Lei Dong
- Central South University Xiangya School of Nursing, Changsha, Hunan, China
| | - Liang Wang
- Central South University Xiangya School of Nursing, Changsha, Hunan, China
| | - Hongyu Zhao
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiao Zhu
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
- Research Center of Chinese Health Ministry on Transplantation Medicine Engineering and Technology, Changsha, Hunan, China
| | - Zhihao Zhang
- School of Public Administration, Central South University, Changsha, Hunan, China
| | - Jia Liu
- Nursing Department, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
- Nursing Department, Hunan Provincial People's Hospital (The First Hospital Affiliated with Hunan Normal University), Changsha, Hunan, China
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Oliveira LCLDM, Tavares RPM, Moreira FSM, Nóbrega ÍMFD, Nogueira TCC, Oliveira ABD, Batista LDM, Martins RR, Oliveira AG. Development and Internal Validation of a Questionnaire Assessing Predisposition to Nonadherence to Immunosuppressive Medication in Kidney Pretransplant Patients. Transplantation 2024; 108:284-293. [PMID: 37638863 DOI: 10.1097/tp.0000000000004758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND After kidney transplant, nonadherence to immunosuppressive therapy is the main cause of impaired kidney function and graft loss. The objective of this study was the development and internal validation of a clinical questionnaire for assessing the predisposition to adherence to immunosuppressive therapy in kidney pretransplant patients. METHODS Multicenter prospective study conducted in 7 kidney hemodialysis and 6 kidney transplant centers of 3 Brazilian state capitals. Kidney transplant candidate patients of both sexes and >18-y-old were included. Retransplanted patients were excluded. A 72-item pilot version of the questionnaire, created through literature review complemented with a focus group of 8 kidney pretransplant patients, was administered to 541 kidney transplant candidate patients. Factor analysis with varimax rotation was used for questionnaire development. Internal validity evaluation used Cronbach's alpha and test-retest reliability. Construct validity was assessed by differentiation by known groups. RESULTS The final questionnaire, named Kidney AlloTransplant Immunosuppressive Therapy Adherence (KATITA) Questionnaire, consisting of 25 items in 3 dimensions, presented good internal consistency reliability (Cronbach's alpha 0.81). The 3 dimensions and respective Cronbach's alpha were "Carelessness" (14 items, 0.81), "Skepticism" (6 items, 0.57), and "Concern" (5 items, 0.62). The interdimension correlation matrix showed low correlation coefficients (<0.35). Test-retest reliability, evaluated with 154 patients, showed an intraclass correlation coefficient of 0.62 (moderate agreement). The scale showed construct validity. CONCLUSIONS The KATITA-25 questionnaire is the first psychometric instrument for evaluation of predisposition to nonadherence to immunosuppressive medication in candidate patients for kidney transplant in the pretransplant setting.
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Affiliation(s)
- Luana Cristina Lins de Medeiros Oliveira
- Graduate Program in Pharmaceutical Sciences, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal-RN, Brazil
- Clinical Pharmacy Unit, Onofre Lopes University Hospital, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal-RN, Brazil
| | | | | | - Ítala Morgânia Farias da Nóbrega
- Faculdade Pernambucana de Saúde, Recife-PE, Brazil
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife-PE, Brazil
| | | | - Alene Barros de Oliveira
- Clinical Pharmacy Unit, Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza-CE, Brazil
| | | | - Rand Randall Martins
- Graduate Program in Pharmaceutical Sciences, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal-RN, Brazil
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal-RN, Brazil
| | - Antonio Gouveia Oliveira
- Graduate Program in Pharmaceutical Sciences, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal-RN, Brazil
- Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal-RN, Brazil
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Marston MT, Berben L, Dobbels F, Russell CL, de Geest S. Prevalence and Patient-Level Correlates of Intentional Non-Adherence to Immunosuppressive Medication After Heart-Transplantation-Findings From the International BRIGHT Study. Transpl Int 2023; 36:11308. [PMID: 37492859 PMCID: PMC10363605 DOI: 10.3389/ti.2023.11308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/15/2023] [Indexed: 07/27/2023]
Abstract
After heart transplantation (HTx), non-adherence to immunosuppressants (IS) is associated with poor outcomes; however, intentional non-adherence (INA) is poorly understood regarding its international variability in prevalence, contributing factors and impact on outcomes. We investigated (1) the prevalence and international variability of INA, (2) patient-level correlates of INA, and (3) relation of INA with clinical outcomes. Secondary analysis of data from the BRIGHT study-an international multi-center, cross-sectional survey examining multi-level factors of adherence in 1,397 adult HTx recipients. INA during the implementation phase, i.e., drug holiday and dose alteration, was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale© (BAASIS©). Descriptive and inferential analysis was performed with data retrieved through patient interview, patient self-report and in clinical records. INA prevalence was 3.3% (n = 46/1,397)-drug holidays: 1.7% (n = 24); dose alteration: 1.4% (n = 20); both: 0.1% (n = 2). University-level education (OR = 2.46, CI = 1.04-5.83), insurance not covering IS costs (OR = 2.21, CI = 1.01-4.87) and barriers (OR = 4.90, CI = 2.73-8.80) were significantly associated with INA; however, clinical outcomes were not. Compared to other single-center studies, this sample's INA prevalence was low. More than accessibility or financial concerns, our analyses identified patient-level barriers as INA drivers. Addressing patients' IS-related barriers, should decrease INA.
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Affiliation(s)
- Mark T. Marston
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Pediatric Intensive Care Unit, University Children’s Hospital Basel, Basel, Switzerland
| | - Lut Berben
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Pediatric Intensive Care Unit, University Children’s Hospital Basel, Basel, Switzerland
| | - Fabienne Dobbels
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Cynthia L. Russell
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Sabina de Geest
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Comparing patient acceptability of MR-guided radiotherapy to conventional CBCT on two Elekta systems: a questionnaire-based survey. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background and Purpose:
The magnetic resonance linear accelerator system (MR Linac) is a novel piece of radiotherapy (RT) equipment allowing the routine application of daily MR-guided treatment adaptation. The hardware design required for such technical capabilities and the increased complexity of the treatment workflow entails a notable departure from cone beam computed tomography (CBCT)-based RT. Patient tolerability of treatment is paramount to RT practice where high compliance is required. Presented is a comparative analysis of how such modality specific characteristics may ultimately impact the patient experience of treatment.
Materials and Methods:
Forty patients undergoing RT for prostate cancer (PCa) on either the MR Linac (n = 20) or a CBCT-based linac (n = 20) were provided with a validated patient reported outcomes measures (PROM’s) questionnaire at fraction 1 and fraction 20. The 18-item questionnaire provided patient responses recorded using a 4-point Likert scale, 0 denoting a response of ‘Not at all’, 1 ‘Slightly’, 2 ‘Moderately’ and 3 signifying ‘Very’. The analysis provided insight into both comparisons between modalities at singular time points (fractions 1 and 20), as well as a temporal analysis within a single modality, denoting changing patient experience.
Results:
Patients generally found the MR Linac treatment couch more comfortable, however, found the increase in treatment duration harder to tolerate. Responses for all items remained stable between first and last fraction across both cohorts, indicating minimal temporal variation within a single modality. None of the responses were statistically significant at the 0·01 level.
Conclusion:
Whether radiotherapy for PCa is delivered on a CBCT linac or the MR Linac, there is little difference in patient experience with minimal experiential variation within a single modality.
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He QH, Zheng J, Liu JL, Wang J, You LM. Predictors of Medication Adherence of Patients With Coronary Heart Disease After Percutaneous Coronary Intervention: A Structural Equation Modeling Based on the Extended Theory of Planned Behavior. J Cardiovasc Nurs 2022; 37:350-358. [PMID: 37707968 DOI: 10.1097/jcn.0000000000000755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The theory of planned behavior (TPB), combined with social support, forms the extended TPB, which has shown to predict adherence to health-related behavior effectively, but few studies have applied it to explain medication adherence in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). OBJECTIVES The aim of this study was to explore the factors associated with medication adherence and the underlying mechanisms based on the extended TPB among patients with CHD after PCI. METHODS A cross-sectional descriptive study was conducted among patients with CHD after PCI in 2 major hospitals in Guangzhou, China. Medication adherence was measured with the Medication Adherence Report Scale. Constructs of the TPB contributing to medication adherence were assessed by the Theory of Planned Behavior Questionnaire for Medication Adherence. Social support was measured by the Multidimensional Scale of Perceived Social Support. Structural equation modeling was used to examine the hypotheses based on the extended TPB. RESULTS A total of 300 patients were surveyed and 26.0% of them were nonadherent. The structural equation modeling had good fit indices and estimated 62.6% of the variance in medication adherence. Regarding the relationships between the extended TPB constructs and medication adherence, "intention" was directly associated with medication adherence, and "perceived behavioral control" positively predicted medication adherence directly and indirectly. "Affective attitude" and "subjective norm" were indirectly associated with medication adherence through "intention." Social support exerted an indirect effect on medication adherence through "subjective norm." CONCLUSIONS The extended TPB is an appropriate model to predict medication adherence and provides an effective framework for adherence-enhancing interventions.
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Time-Limited Therapy with Belatacept in Kidney Transplant Recipients. J Clin Med 2022; 11:jcm11113229. [PMID: 35683619 PMCID: PMC9181670 DOI: 10.3390/jcm11113229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/28/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: In kidney transplant recipients, belatacept is usually pursued indefinitely after it has been started. In the setting of the belatacept shortage and after having evaluated the benefit–risk ratio, we established a strategy consisting of time-limited belatacept therapy/transient calcineurin inhibitor withdrawal, whose results are analyzed in that study. Methods: We considered all the kidney transplant recipients that had been switched from conventional immunosuppressive therapy to belatacept and then for whom belatacept has been withdrawn intentionally. Furthermore, in the first 8 patients, we assessed changes in peripheral blood mononuclear cells (PBMC) transcriptome using RNAseq before and 3 months after belatacept withdrawal. Results: Over the study period, 28 out of 94 patients had belatacept intentionally withdrawn including 25 (89%) switched to low-dose CNI. One rejection due to poor compliance occurred. The eGFR after 12 months remained stable from 48 ± 19 mL.1.73 m−2 to 46 ± 17 mL.1.73 m−2 (p = 0.68). However, patients that resumed belatacept/withdrew CNIs (n = 10) had a trend towards a better eGFR comparing with the others (n = 15): 54 ± 20 mL.1.73 m−2 vs. eGFR 43 ± 16 mL.1.73 m−2, respectively (p = 0.15). The only factor associated with belatacept resumption was when the withdrawal took place during the COVID-19 outbreak. Transcriptome analysis of PBMCs, did not support rebound in alloimmune response. Conclusions: These findings underpin the use of belatacept as part of a time-limited therapy, in selected kidney transplant recipients, possibly as an approach to allow efficient vaccination against SARS-CoV-2.
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Yang L, Liu HX, Hu Y, Zhang B, Peng FC, Wei CY, Wang RT. Exploration of Adherence to the Immunosuppressive Medication in Kidney Transplant Recipients Based on Theory of Planned Behavior. Clin Nurs Res 2022; 31:1189-1198. [PMID: 35575261 DOI: 10.1177/10547738221096550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To investigate adherence to immunosuppressive medication (IM) in kidney transplant recipients (KTRs) and analyze the associated factors using the Theory of Planned Behavior (TPB). Data were collected at Time1 (T1) and 3 months later (T2). T1: the elements of the TPB, past behavior, beliefs about medicines, perceived social support were measured. T2: IM adherence was measured. Structural equation modeling was applied to analyze the associated factors of medication adherence. A total of 246 KTRs were included. The average IM adherence score of KTRs' was 4.86 (SD = 1.63). Of the recipients, 39.43% had one aspect of non-adherence to IM. The model could explain 28.7% of the variance in adherence to IM (R2 = .287, p = .006). TPB is a useful tool for understanding adherence to IM in KTRs. Caregivers can provide effective interventions during follow-up, which should focus on improving medication beliefs as well as provision of other external support especially from outside.
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Affiliation(s)
- Luo Yang
- Beijing University of Chinese Medicine, China
| | | | - Yue Hu
- Chongqing Traditional Chinese Medicine Hospital, China
| | - Bei Zhang
- Beijing University of Chinese Medicine, China
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The Impact of Socio-Demographic Factors on the Functioning of Liver Transplant Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074230. [PMID: 35409911 PMCID: PMC8998949 DOI: 10.3390/ijerph19074230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 01/05/2023]
Abstract
(1) Background: The aim of this study was to evaluate the influence of socio-demographic factors and the time elapsed since liver transplantation on the functioning of patients after liver transplantation; (2) Methods: This is a survey-based prospective cohort study of 112 patients, performed using: The Inventory of Socially Supportive Behaviors (ISSB), The Acceptance of Illness Scale (AIS), the Beck Depression Inventory (BDI), and a questionnaire concerning sociodemographic data prepared using the Delphi method; (3) Results: Subjects under 40 years of age reported the highest social support. The longer the time since surgery, the lower the levels of adherence and support; (4) Conclusions: 1. In the study group, most support was received by women, people under 40 years of age, and those with secondary education. However, the level of social support decreased over time after the liver transplant operation. Patients who had undergone previous transplantation showed lower levels of adherence to therapeutic recommendations. 2. Patients who were in a relationship showed higher levels of illness acceptance than single ones. Women were more likely to experience depressive symptoms than men. 3. The time since liver transplantation is an important factor that affects patients' functioning. This is a time when patients need more care, social support, and assistance in maintaining adherence to therapeutic recommendations.
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Birkefeld K, Bauer-Hohmann M, Klewitz F, Kyaw Tha Tun EM, Tegtbur U, Pape L, Schiffer L, Schiffer M, de Zwaan M, Nöhre M. Prevalence of Mental Disorders in a German Kidney Transplant Population: Results of a KTx360°-Substudy. J Clin Psychol Med Settings 2022; 29:963-976. [PMID: 35195827 DOI: 10.1007/s10880-022-09861-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/26/2022]
Abstract
In patients after kidney transplantation (KTx) an increased rate of affective and anxiety disorders has been observed. Repeatedly, a relationship between mental health issues and increased morbidity and mortality in KTx recipients has been reported. However, information on the prevalence of mental disorders in KTx patients is scarce. As part of the structured multimodal follow-up program (KTx360°), mental disorders were examined in 726 patients after KTx through structured diagnostic interviews using the Mini-DIPS Open Access. Overall, 27.5% had a current and 49.2% a lifetime mental disorder. Only 14.5% with a current mental disorder reported to be in treatment. Affected patients were younger, more often female, reported more symptoms of anxiety and depression and less perceived social support. While comparable to the rate in general population samples, the prevalence of mental disorders should attract attention. The low treatment rate requires an improved identification of afflicted patients and provision of specialist treatment.ISRCTN registry, https://doi.org/10.1186/ISRCTN29416382 , date of registry: 03.05.2017.
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Affiliation(s)
- Katrin Birkefeld
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Institute of Legal Medicine and Forensic Sciences, Charité-Universiätsmedizin, Berlin, Germany
| | - Maximilian Bauer-Hohmann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
| | - Felix Klewitz
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
| | - Eva-Marie Kyaw Tha Tun
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Uwe Tegtbur
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Department of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Lars Pape
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
- Department of Pediatrics II, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Lena Schiffer
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Mario Schiffer
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
| | - Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany.
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Ng YH, Litvinovich I, Leyva Y, Ford CG, Zhu Y, Kendall K, Croswell E, Puttarajappa CM, Dew MA, Shapiro R, Unruh ML, Myaskovsky L. Medication, Healthcare Follow-up, and Lifestyle Nonadherence: Do They Share the Same Risk Factors? Transplant Direct 2022; 8:e1256. [PMID: 34912945 PMCID: PMC8670587 DOI: 10.1097/txd.0000000000001256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/14/2021] [Accepted: 10/06/2021] [Indexed: 12/20/2022] Open
Abstract
Barriers to medication adherence may differ from barriers in other domains of adherence. In this study, we assessed the association between pre-kidney transplantation (KT) factors with nonadherent behaviors in 3 different domains post-KT. METHODS We conducted a prospective cohort study with patient interviews at initial KT evaluation (baseline-nonadherence predictors in sociodemographic, condition-related, health system, and patient-related psychosocial factors) and at ≈6 mo post-KT (adherence outcomes: medications, healthcare follow-up, and lifestyle behavior). All patients who underwent KT at our institution and had ≈6-mo follow-up interview were included in the study. We assessed nonadherence in 3 different domains using continuous composite measures derived from the Health Habit Survey. We built multiple linear and logistic regression models, adjusting for baseline characteristics, to predict adherence outcomes. RESULTS We included 173 participants. Black race (mean difference in adherence score: -0.72; 95% confidence interval [CI], -1.12 to -0.32) and higher income (mean difference: -0.34; 95% CI, -0.67 to -0.02) predicted lower medication adherence. Experience of racial discrimination predicted lower adherence (odds ratio, 0.31; 95% CI, 0.12-0.76) and having internal locus of control predicted better adherence (odds ratio, 1.46; 95% CI, 1.06-2.03) to healthcare follow-up. In the lifestyle domain, higher education (mean difference: 0.75; 95% CI, 0.21-1.29) and lower body mass index (mean difference: -0.08; 95% CI, -0.13 to -0.03) predicted better adherence to dietary recommendations, but no risk factors predicted exercise adherence. CONCLUSIONS Different nonadherence behaviors may stem from different motivation and risk factors (eg, clinic nonattendance due to experiencing racial discrimination). Thus adherence intervention should be individualized to target at-risk population (eg, bias reduction training for medical staff to improve patient adherence to clinic visit).
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Affiliation(s)
- Yue-Harn Ng
- Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Igor Litvinovich
- Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Yuridia Leyva
- Center for the Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, Albuquerque, NM
| | - C. Graham Ford
- Center for the Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, Albuquerque, NM
| | - Yiliang Zhu
- Division of Epidemiology, Biostatistics and Preventive Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | | | - Emilee Croswell
- Department of Medicine, School of Medicine, University of Pittsburgh, PA
| | | | - Mary Amanda Dew
- Department of Psychiatry, School of Medicine, University of Pittsburgh, PA
| | - Ron Shapiro
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine
| | - Mark L. Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Larissa Myaskovsky
- Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, NM
- Center for the Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, Albuquerque, NM
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Hussain T, Nassetta K, O'Dwyer LC, Wilcox JE, Badawy SM. Adherence to immunosuppression in adult heart transplant recipients: A systematic review. Transplant Rev (Orlando) 2021; 35:100651. [PMID: 34592641 DOI: 10.1016/j.trre.2021.100651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/24/2021] [Accepted: 09/13/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Successful maintenance of a heart transplant (HTx) graft requires adherence to a triple-drug regimen of immunosuppression. However, achieving adequate adherence can be difficult secondary to complicated dosing regimens, side effects, and mental/emotional barriers. A detailed review of current patterns of adherence to immunosuppression in adult HTx recipients is lacking. OBJECTIVE This systematic review aims to detail the current landscape of adherence to immunosuppression in adult heart transplant patients, including the measurement of adherence, correlates to adherence, health outcomes associated with nonadherence, as well as strategies to improve adherence in HTx patients. METHODS We conducted searches in PubMed MEDLINE, Embase, CENTRAL register of Controlled Trials (Wiley), and Scopus, from inception to March 2020. Studies were eligible if they outlined an aspect of adherence (as noted above in the objective) to immunosuppression in adult HTx patients. The HTx cohort had to contain at least 10 patients and measurement of adherence had to be done with an objective or otherwise validated measure of adherence (e.g. drug levels, automated pill bottles or adherence questionnaires). Two authors independently screened the articles for inclusion, then subsequently reviewed the full texts of the included articles. Data was extracted into standardized forms and bias evaluations were done using the Newcastle-Ottawa or modified Newcastle-Ottawa tools, depending on the study type. The authors followed all guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS The titles/abstracts of 880 articles were reviewed. Ultimately, 23 articles were included in the final review. The median number of participants was 101, with a range of 19 to 1397. Studies provided information on baseline levels of adherence (17 studies), correlates to adherence (14 studies), health outcomes related to nonadherence (3 studies) and interventions to improve adherence (3 studies). Baseline adherence estimates varied greatly depending on the adherence measure. Multiple significant correlates to nonadherence exist and appear to affect patients with certain sociodemographic backgrounds, those with psychological/psychiatric comorbidities and those with poor support structures. Nonadherence is associated with transplant coronary artery disease and acute late rejection; it may also be associated with long-term mortality. Finally, a simplified dosing regimen with once-a-day tacrolimus as well as use of a mobile phone-based intervention were associated with improved adherence. Bias scores were most deficient due to self-reported outcomes in 18 studies, and lack of controls/adjustments for confounders, in 7 studies. CONCLUSIONS Adherence to immunosuppression in transplant patients varies, but is associated with observable and modifiable factors which are worth addressing. Further high-quality studies regarding strategies to improve adherence are needed in the literature.
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Affiliation(s)
- Tasmeen Hussain
- Department of Internal Medicine, Northwestern University McGaw Medical Center, 251 E. Huron St., Ste. 16-738, Chicago, IL 60611, USA.
| | - Keira Nassetta
- Department of Pediatrics, Lurie Children's Hospital, 225 E. Chicago Ave., Chicago, IL 60611, USA.
| | - Linda C O'Dwyer
- Galter Health Sciences Library & Learning Center, Northwestern University Feinberg School of Medicine, 320 E. Superior Street, Chicago, IL 60611, USA.
| | - Jane E Wilcox
- Department of Cardiology, Northwestern Memorial Hospital, NMH/Arkes Family Pavilion, Ste. 600; 676 N. St. Clair Ave., Chicago, IL 60611, USA.
| | - Sherif M Badawy
- Division of Hematology, Oncology, and Stem Cell Transplant, Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave., Chicago, IL 60611, USA.
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12
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Designing and Psychometric Properties of Appraisal Adherence to Care and Treatment Scale in Liver Transplantation Recipients. HEPATITIS MONTHLY 2021. [DOI: 10.5812/hepatmon.113911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Background: Care and treatment adherence are important factors for given good liver transplantation outcomes. Objectives: Design and validate an instrument to appraise adherence to care and treatment in liver transplantation recipients. Methods: A mixed-methods sequential exploratory study was conducted in two phases from 2017 to 2019, in the Liver Transplantation Clinic Tehran, Iran. In the qualitative phase, the concept of care and treatment adherence in liver transplantation recipients extracted by a conventional content analysis was performed on semi-structural interviews that were conducted on 18 liver transplantation recipients that were recruited through purposive sampling technique. Also, two physicians, one nurse coordinator of the liver transplantation team, and two family members were interviewed. The scale was developed based on operational definitions extracted from the qualitative phase. The validity was assessed by face, content, construct validity, and confirmatory factor analysis. The reliability was also evaluated by calculating test-retest intraclass correlation coefficient and Cronbach's alpha. The exploratory factor analysis was carried out with 286 filled the questionnaire. Results: Four factors were extracted in factor analysis. These factors explained 45.622% of the variance. The final version of the scale consisted of 20 items. The Cronbach's alpha coefficient reported as 0.889 for the total scale and the intraclass correlation coefficient was reported as 0.912. The confirmatory factor analysis led to a fitting model. Chi-square indices were reported as CMIN/DF = 2.34, NFI = 0.94, CFI = 0.96, and RAMSEA = 0.067. Conclusions: With a four factors structure, validity and reliability of adherence to care and treatment scale are acceptable; therefore, it can be used for appraisal care and treatment adherence in liver transplant recipients.
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Zhang P, Zhu X, Yan J, Liu J. Identification of Immunosuppressive Medication Nonadherence Factors Through a Combined Theory Model in Renal Transplant Recipients: 6-12. Front Pharmacol 2021; 12:655836. [PMID: 34122077 PMCID: PMC8187913 DOI: 10.3389/fphar.2021.655836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/07/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Immunosuppressive medication (IM) nonadherence is associated with poor transplant outcomes. Therefore, it is of great importance to identify predictive factors with IM nonadherence. We aimed to improve the predicted capacity of the theory of planned behavior (TPB) by adding health belief model's (HBM) variables in renal transplant patients (RTPs). Methods: This cross-sectional study distributed questionnaires to patients who had undergone renal transplant and follow-up regularly in the transplant center of Third Xiangya Hospital in China. The self-developed questionnaire collected data in three aspects: general data questionnaire, TPB, HBM-specific questionnaire, and Basel Assessment of Adherence to Immunosuppressive Medications scale. Results: A total of 1,357 of 1,480 patients completed the survey, with a participation rate of 91.69% and IM nonadherence rate of 33.53%. The marital status, household income, preoperative drinking history, the time after transplantation, and religion showed independent predictive factors with IM nonadherence (p < 0.05). Strikingly, adding HBM variables to the TPB theory model significantly increased its prediction ability to IM nonadherence (52%). Also, HBM manifested the highest coefficient of effect (-0.620). Particularly, perceived barriers and perceived seriousness, the variables of the HBM model, played a vital influence on medication nonadherence (-0.284 and 0.256). Conclusion: Our study here reveals the first investigation of the combined effects of the TPB and HBM model on IM nonadherence in Chinese RTPs, which could significantly improve the predictive ability of any single model. Meanwhile, future interventions should be conducted to both increase perceived seriousness and reduce perceived barriers for taking IM, which will effectively decrease IM nonadherence rates and improve transplant outcomes.
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Affiliation(s)
- Pengpeng Zhang
- Department of Transplantation, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiao Zhu
- Department of Transplantation, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jin Yan
- The Nursing Department, the Third Xiangya Hospital of Central South University, Changsha, China
| | - Jia Liu
- Department of Transplantation, The Third Xiangya Hospital of Central South University, Changsha, China.,The Nursing School of Central South University, Changsha, China
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López-Torres López J, Rabanales-Sotos J, López-Torres Hidalgo MR, Milián García RM, López Martínez C, Blázquez Abellán G. Reliability and Validity of the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) in Persons with Arterial Hypertension. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3212. [PMID: 33808854 PMCID: PMC8003792 DOI: 10.3390/ijerph18063212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the reliability and validity of the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) in persons with arterial hypertension undergoing pharmacological treatment, along with its convergent validity with degree of control of blood pressure levels, therapeutic adherence, and tolerability of antihypertensive drugs. METHODS Observational cross-sectional study conducted on a sample of 484 persons. Treatment satisfaction was evaluated with the SATMED-Q, an instrument consisting of 17 items with six dimensions. Other variables were blood pressure, antihypertensive drugs, adverse effects, therapeutic adherence, and participants' characteristics. RESULTS Cronbach's alpha was 0.916. Factor analysis revealed six factors that could account for 89.97% of total variance. The test-retest reliability analysis yielded an intraclass correlation coefficient of 0.910 (95% CI = 0.806-0.959). In a possible range of 0 through 100 points, participant satisfaction with treatment ranged from 38.2 to 100 (mean 79.9 (SD = 12.9; 95% CI = 78.8-81.0); median 80.9). SATMED-Q scores were higher among persons who reported experiencing no adverse effects (82.5 ± 11.6 SD vs. 68.7 ± 11.9 SD; p < 0.001). Satisfaction levels were significantly lower among subjects not complying with the treatment (73.2 ± 12.9 vs. 82.1 ± 12.1; p < 0.001), and significantly higher among those presenting with controlled blood pressure levels (82.1 ± 12.1 SD vs. 77.5 ± 13.3 SD; p < 0.001). CONCLUSIONS The SATMED-Q showed high internal consistency and good stability in the reliability analysis. It is an appropriate instrument for evaluating satisfaction with antihypertensive treatment, both in routine clinical practice and in community pharmacy or clinical research settings.
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Affiliation(s)
| | - Joseba Rabanales-Sotos
- Department of Nursing, Physiotherapy and Occupational Therapy, Albacete Nursing Faculty, University of Castile-La Mancha, 02071 Albacete, Spain
| | - María Rosa López-Torres Hidalgo
- Department of Medical Sciences, Albacete Faculty of Pharmacy, University of Castile-La Mancha, 02008 Albacete, Spain; (M.R.L.-T.H.); (G.B.A.)
| | | | | | - Gemma Blázquez Abellán
- Department of Medical Sciences, Albacete Faculty of Pharmacy, University of Castile-La Mancha, 02008 Albacete, Spain; (M.R.L.-T.H.); (G.B.A.)
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15
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Association Between Neighborhood-level Socioeconomic Deprivation and the Medication Level Variability Index for Children Following Liver Transplantation. Transplantation 2021; 104:2346-2353. [PMID: 32032293 DOI: 10.1097/tp.0000000000003157] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Neighborhood socioeconomic deprivation is associated with adverse health outcomes. We sought to determine if neighborhood socioeconomic deprivation was associated with adherence to immunosuppressive medications after liver transplantation. METHODS We conducted a secondary analysis of a multicenter, prospective cohort of children enrolled in the medication adherence in children who had a liver transplant study (enrollment 2010-2013). Participants (N = 271) received a liver transplant ≥1 year before enrollment and were subsequently treated with tacrolimus. The primary exposure, connected to geocoded participant home addresses, was a neighborhood socioeconomic deprivation index (range 0-1, higher indicates more deprivation). The primary outcome was the medication level variability index (MLVI), a surrogate measure of adherence to immunosuppression in pediatric liver transplant recipients. Higher MLVI indicates worse adherence behavior; values ≥2.5 are predictive of late allograft rejection. RESULTS There was a 5% increase in MLVI for each 0.1 increase in deprivation index (95% confidence interval, -1% to 11%; P = 0.08). Roughly 24% of participants from the most deprived quartile had an MLVI ≥2.5 compared with 12% in the remaining 3 quartiles (P = 0.018). Black children were more likely to have high MLVI even after adjusting for deprivation (adjusted odds ratio 4.0 95% confidence interval, 1.7-10.6). CONCLUSIONS This is the first study to evaluate associations between neighborhood socioeconomic deprivation and an objective surrogate measure of medication adherence in children posttransplant. These findings suggest that neighborhood context may be an important consideration when assessing adherence. Differential rates of medication adherence may partly explain links between neighborhood factors and adverse health outcomes following pediatric liver transplantation.
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Keys AE, Pilch NA, Perez C, Patel N, Meadows H, Fleming JN, Taber DJ. Patient‐reported medication adherence and tolerability: Results of a prospective observational study. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Alison E Keys
- College of Pharmacy Medical University of South Carolina Charleston South Carolina USA
| | - Nicole A. Pilch
- College of Pharmacy Medical University of South Carolina Charleston South Carolina USA
| | - Caroline Perez
- Department of Pharmacy Medical University of South Carolina Charleston South Carolina USA
| | - Neha Patel
- Department of Pharmacy Medical University of South Carolina Charleston South Carolina USA
| | - Holly Meadows
- Department of Pharmacy Medical University of South Carolina Charleston South Carolina USA
| | - James N. Fleming
- Department of Surgery, Division of Transplant Surgery Medical University of South Carolina Charleston South Carolina USA
| | - David J. Taber
- Department of Surgery, Division of Transplant Surgery Medical University of South Carolina Charleston South Carolina USA
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Gomis-Pastor M, Mirabet S, Roig E, Lopez L, Brossa V, Galvez-Tugas E, Rodriguez-Murphy E, Feliu A, Ontiveros G, Garcia-Cuyàs F, Salazar A, Mangues MA. Interdisciplinary Mobile Health Model to Improve Clinical Care After Heart Transplantation: Implementation Strategy Study. JMIR Cardio 2020; 4:e19065. [PMID: 33231557 PMCID: PMC7723747 DOI: 10.2196/19065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/05/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022] Open
Abstract
Background Solid organ transplantation could be the only life-saving treatment for end-stage heart failure. Nevertheless, multimorbidity and polypharmacy remain major problems after heart transplant. A technology-based behavioral intervention model was established to improve clinical practice in a heart transplant outpatient setting. To support the new strategy, the mHeart app, a mobile health (mHealth) tool, was developed for use by patients and providers. Objective The primary objective of this study was to describe the implementation of the mHeart model and to outline the main facilitators identified when conceiving an mHealth approach. The secondary objectives were to evaluate the barriers, benefits, and willingness to use mHealth services reported by heart transplant recipients and cardiology providers. Methods This was an implementation strategy study directed by a multidisciplinary cardiology team conducted in four stages: design of the model and the software, development of the mHeart tool, interoperability among systems, and quality and security requirements. A mixed methods study design was applied combining a literature review, several surveys, interviews, and focus groups. The approach involved merging engineering and behavioral theory science. Participants were chronic-stage heart transplant recipients, patient associations, health providers, stakeholders, and diverse experts from the legal, data protection, and interoperability fields. Results An interdisciplinary and patient-centered process was applied to obtain a comprehensive care model. The heart transplant recipients (N=135) included in the study confirmed they had access to smartphones (132/135, 97.7%) and were willing to use the mHeart system (132/135, 97.7%). Based on stakeholder agreement (>75%, N=26), the major priorities identified of the mHealth approach were to improve therapy management, patient empowerment, and patient-provider interactions. Stakeholder agreement on the barriers to implementing the system was weak (<75%). Establishing the new model posed several challenges to the multidisciplinary team in charge. The main factors that needed to be overcome were ensuring data confidentiality, reducing workload, minimizing the digital divide, and increasing interoperability. Experts from various fields, scientific societies, and patient associations were essential to meet the quality requirements and the model scalability. Conclusions The mHeart model will be applicable in distinct clinical and research contexts, and may inspire other cardiology health providers to create innovative ways to deal with therapeutic complexity and multimorbidity through health care systems. Professionals and patients are willing to use such innovative mHealth programs. The facilitators and key strategies described were needed for success in the implementation of the new holistic theory–based mHealth strategy.
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Affiliation(s)
- Mar Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sonia Mirabet
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eulalia Roig
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Lopez
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Vicens Brossa
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Elisabeth Galvez-Tugas
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Anna Feliu
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gerardo Ontiveros
- Information System Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Albert Salazar
- Director Manager, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - M Antonia Mangues
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Lieb M, Weyand M, Seidl M, Erim Y. Prospective single-centre clinical observational study on electronically monitored medication non-adherence, its psychosocial risk factors and lifestyle behaviours after heart transplantation: a study protocol. BMJ Open 2020; 10:e038637. [PMID: 33033024 PMCID: PMC7542932 DOI: 10.1136/bmjopen-2020-038637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION In heart transplant recipients (HTRs), non-adherence (NA) to immunosuppressive (IS) medication and to recommended lifestyle behaviours are a common phenomenon and associated with higher risk of allograft rejection, organ loss and mortality. Risk factors for NA are highly diverse and still insufficiently researched. Precise measures of NA and an accurate understanding of its aetiology are of undisputable importance to detect patients at risk and intervene accordingly. The aim of this study is to assess the accuracy and concordance of different measures for NA as well as to determine potential risk factors. METHODS AND ANALYSIS This is a single-centre prospective observational trial. HTRs who are at least aged 18 are no less than 6 months post-transplant and receive tacrolimus (Prograf or Advagraf), cyclosporine (Sandimmun) or everolimus (Certican) as their prescribed IS medication are eligible for participation. We only include patients during the phase of medication implementation. At study enrolment, we assess depression, health-related quality of life, self-efficacy, social support, attachment, experiences and attitudes towards IS medication, emotional responses after transplantation, satisfaction with information about IS medication and perceptions and beliefs about medications. We further ask patients to rate their lifestyle behaviours concerning alcohol, smoking, diet, physical activity, sun protection and appointment keeping via questionnaires. Three different measurement methods for NA are applied at T0: self-reports, physician's estimates and IS trough levels. NA is monitored prospectively using an electronic multicompartment pillbox (MEMS, VAICA) over a 3-month period. Meanwhile, participants receive phone calls every second week to obtain additional self-reports, resulting in a total of seven measurement points. ETHICS AND DISSEMINATION The study was approved by the Clinical Ethics Committee of the University Hospital Erlangen (Friedrich-Alexander-University, Erlangen-Nürnberg). Written informed consent is attained from all participants. The results of this study will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER DRKS00020496.
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Affiliation(s)
- Marietta Lieb
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Weyand
- Department of Cardiac Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Margot Seidl
- Department of Cardiac Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Belaiche S, Décaudin B, Caron A, Depas N, Vignaux C, Vigouroux S, Coiteux V, Magro L, Sirvent A, Huynh A, Turlure P, Farge D, Lioure B, Bruno B, De Berranger E, Maillard N, Bourhis JH, Bay JO, Bulabois CE, Ceballos P, Fegueux N, Hicheri Y, Vincent L, Rialland F, Gandemer V, Taque S, Cornillon J, Contentin N, Galambrun C, Plantaz D, Odou P, Yakoub-Agha I. Medication non-adherence after allogeneic hematopoietic cell transplantation in adult and pediatric recipients: a cross sectional study conducted by the Francophone Society of Bone Marrow Transplantation and Cellular Therapy. Fundam Clin Pharmacol 2020; 35:435-445. [PMID: 32740936 DOI: 10.1111/fcp.12593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 06/09/2020] [Accepted: 07/27/2020] [Indexed: 12/14/2022]
Abstract
Medication non-adherence (NA) after allogeneic hematopoietic cell transplantation (allo-HCT) can lead to serious complications. This study assesses NA in French adult and pediatric recipients and identifies factors associated with NA. In accordance with the EMERGE and STROBE guidelines, a cross sectional multicentric survey was conducted. We used a self-reported questionnaire that was adapted to adults and pediatrics and that could provide a picture of all three phases of medication adherence: initiation, implementation, persistence. We enrolled 242 patients, 203 adults (mean age: 51 years old, 50.7% male) and 39 children (mean age: 9 years old, 56.4% female). Reported NA was estimated at about 75% in both populations, adults and pediatrics. In adults, the univariate analysis showed that patients less than 50 years old (P = 0.041), (i) treated with cyclosporine (P = 0.02), (ii) treated with valacyclovir/acyclovir (P = 0.016), and (iii) experiencing side effects (P = 0.009), were significantly more non-adherent. In multivariate analysis, only recipient age was significantly associated to NA (P = 0.05). The limited size of the pediatric population did not allow us to draw any statistical conclusion about this population. To the best of our knowledge, this is the first study in France on NA in allo-HCT recipients. Our results highlight the age factor as the only factor related to NA. Further studies are needed to confirm our observations and refine results in pediatric populations, currently most at risk of medication NA.
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Affiliation(s)
| | | | - Alexandre Caron
- EA 2694 - Santé publique: épidémiologie et qualité des soins, CHU Lille, Univ. Lille, Lille, F-59000, France
| | - Nicolas Depas
- EA 2694 - Santé publique: épidémiologie et qualité des soins, CHU Lille, Univ. Lille, Lille, F-59000, France
| | - Claire Vignaux
- Service Hématologie Adulte, CHU Bordeaux, Bordeaux Cedex, F-33076, France
| | - Stephane Vigouroux
- Service Hématologie Adulte, CHU Bordeaux, Bordeaux Cedex, F-33076, France
| | | | | | - Anne Sirvent
- Service Hématologie Pédiatrique, CHU Montpellier, Montpellier, F-34090, France
| | - Anne Huynh
- Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse Cedex 9, F-31059, France
| | - Pascal Turlure
- Service Hématologie Adulte, CHU Dupuytren, Limoges Cedex, F-87042, France
| | - Dominique Farge
- Service Hématologie Adulte, APHP- Hopital Saint Louis, Paris, F-75010, France
| | - Bruno Lioure
- Service Hématologie Adulte, Hopital de Hautepierre, CHU de Strasbourg, Strasbourg, F-67200, France
| | - Bénédicte Bruno
- Service Hématologie Pédiatrique, CHU Lille, Lille, F-59000, France
| | - Eva De Berranger
- Service Hématologie Pédiatrique, CHU Lille, Lille, F-59000, France
| | - Natacha Maillard
- Service Hématologie Adulte, CHU Poitier, Poitier, F-86000, France
| | - Jean-Henri Bourhis
- Service Hématologie Adulte, Institut Gustave Roussy, Villejuif Cedex, F-94805, France
| | | | | | - Patrice Ceballos
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Nathalie Fegueux
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Yosr Hicheri
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Laure Vincent
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Fanny Rialland
- Service Hématologie Pédiatrique, CHU Nantes, Nantes, F-44000, France
| | - Virginie Gandemer
- Service Hématologie Pédiatrique, CHU Rennes, Rennes Cedex 9, F-35033, France
| | - Sophie Taque
- Service Hématologie Pédiatrique, CHU Rennes, Rennes Cedex 9, F-35033, France
| | - Jérôme Cornillon
- Service Hématologie Adulte, Institut de Cancérologie Lucien Neuwirth, Saint Etienne, F-42000, France
| | - Nathalie Contentin
- Service Hématologie Adulte, Centre Henri Becquerel, Rouen Cedex, F 76038, France
| | - Claire Galambrun
- Service Hématologie Pédiatrique, APHM Hopital La Timone, Marseille, F-13005, France
| | - Dominique Plantaz
- Service Hématologie Pédiatrique, CHU Grenoble, La Tronche, F-38700, France
| | - Pascal Odou
- Institut de Pharmacie, CHU Lille, Lille, F-59000, France
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Roustit M, Chaumais MC, Chapuis C, Gairard-Dory A, Hadjadj C, Chanoine S, Allenet B, Sitbon O, Pison C, Bedouch P. Evaluation of a collaborative care program for pulmonary hypertension patients: a multicenter randomized trial. Int J Clin Pharm 2020; 42:1128-1138. [PMID: 32440738 DOI: 10.1007/s11096-020-01047-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
Background Pulmonary hypertension is a rare, chronic and life-threatening group of diseases. Recent advances in pulmonary hypertension management prolong survival and improve quality-of-life. However, highly complex drug therapy enhances the risk of drug-related problems. Objective To assess the impact of involving clinical pharmacists in the collaborative care of pulmonary hypertension patients. Setting Ten French University Hospital Pneumology departments, all members of the French Network for Pulmonary Hypertension. Methods This prospective multicenter randomized controlled trial included incident pulmonary hypertension patients who were followed-up for 18 months. Randomization using an adapted Zelen method allocated patients to collaborative care (n = 41) or usual care groups (n = 51). A collaborative care program involving clinical pharmacists was developed through a close partnership between with physicians, nurses and pharmacists. Besides usual care, the program includes regular one-to-one interviews between the pharmacist and the patient. These interviews had following objectives: to perform an exhaustive medication history review; to identify the patient' needs, knowledge and skills; to define educational objectives and to provide patients with relevant information when needed. Following each interview, a standardized report form containing the pharmacist's recommendations was provided to physicians and nurses and discussed collaboratively. An ancillary economic analysis was performed. Main outcome measure Number of drug-related problems and their outcomes. Results The number of drug-related problems was not significantly different between groups (1.6 ± 1.5 vs. 1.9 ± 2.4; p = 0.41). More problems were resolved in the collaborative care group than in the usual care group (86.5% vs. 66.7%, p = 0.01). Time to clinical worsening, therapeutic adherence, satisfaction or quality-of-life were not statistically different between groups. Collaborative care decreased costs of drug-related hospitalizations. Conclusion Including clinical pharmacists in the multidisciplinary care of hospitalized patients with pulmonary hypertension improved the outcome of drug-related problems and reduced the costs of related hospitalization. However, we observed no efficacy on medication errors, clinical outcomes or medication adherence. Clinical Trial Registration ClinicalTrials.gov Identifier NCT01038284.
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Affiliation(s)
- Matthieu Roustit
- Faculty of Medicine and Pharmacy, Grenoble Alpes University, 38000, Grenoble, France. .,INSERM U1042- HP2 Laboratory, 38000, Grenoble, France. .,Clinical Pharmacology- INSERM CIC1406, Research Division, Grenoble Alpes University Hospital, 38000, Grenoble, France.
| | - Marie-Camille Chaumais
- Faculty of Pharmacy, Paris-Sud University, 92290, Châtenay Malabry, France.,Pharmacy Department, DHU Thorax Innovation, Antoine Béclère Hospital, Paris Hospitals, 92140, Clamart, France.,INSERM UMR_S 999, Marie Lannelongue Surgery Center, 92350, Le Plessis Robinson, France
| | - Claire Chapuis
- Faculty of Medicine and Pharmacy, Grenoble Alpes University, 38000, Grenoble, France
| | - Anne Gairard-Dory
- Pharmacy Department, Strasbourg University Hospital, 67000, Strasbourg, France
| | - Caroline Hadjadj
- Health Products Division, Bordeaux University Hospital, 33600, Pessac, France
| | - Sébastien Chanoine
- Faculty of Medicine and Pharmacy, Grenoble Alpes University, 38000, Grenoble, France.,INSERM U823 - Albert Bonniot Institute, 38000, Grenoble, France.,CNRS, TIMC-IMAG, 38000, Grenoble, France
| | - Benoît Allenet
- Faculty of Medicine and Pharmacy, Grenoble Alpes University, 38000, Grenoble, France.,CNRS, TIMC-IMAG, 38000, Grenoble, France
| | - Olivier Sitbon
- INSERM UMR_S 999, Marie Lannelongue Surgery Center, 92350, Le Plessis Robinson, France.,Faculty of Medicine, Paris-Sud University, 94270, Le Kremlin-Bicêtre, France.,Pneumology Department, Bicêtre Hospital, Paris Hospitals, 94270, Le Kremlin-Bicêtre, France
| | - Christophe Pison
- Faculty of Medicine and Pharmacy, Grenoble Alpes University, 38000, Grenoble, France.,Fundamental and Applied Bioenergetics Laboratory, INSERM U1055, 38000, Grenoble, France.,University Pneumology Clinic, Thorax and Vessels Division, Grenoble Alpes University Hospital, 38000, Grenoble, France
| | - Pierrick Bedouch
- Faculty of Medicine and Pharmacy, Grenoble Alpes University, 38000, Grenoble, France.,CNRS, TIMC-IMAG, 38000, Grenoble, France
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21
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Gomis-Pastor M, Roig E, Mirabet S, T De Pourcq J, Conejo I, Feliu A, Brossa V, Lopez L, Ferrero-Gregori A, Barata A, Mangues MA. A Mobile App (mHeart) to Detect Medication Nonadherence in the Heart Transplant Population: Validation Study. JMIR Mhealth Uhealth 2020; 8:e15957. [PMID: 32014839 PMCID: PMC7055830 DOI: 10.2196/15957] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/18/2019] [Accepted: 12/16/2019] [Indexed: 01/17/2023] Open
Abstract
Background Medication nonadherence in heart transplant recipients (HTxR) is related to graft loss and death. mHeart is a mobile app that uses electronic patient-reported outcome measures (ePROMs) to identify and manage medication nonadherence in the outpatient heart transplant (HTx) population. Objective The study primarily aimed to validate mHeart to measure medication nonadherence in early stage HTxR by assessing the psychometric properties of ePROMs. The secondary aims were to (1) measure patient satisfaction with the mHeart tool and its usability and (2) explore the impact of a theory-based treatment on medication nonadherence rates to determine its scalability to larger research. Methods A prospective study was conducted in the outpatient clinic of a tertiary hospital. All consecutive early stage HTxR (<1.5 years from HTx) were included. The ePROM psychometric properties assessed were validity, reliability, responsiveness, interpretability, and burden. ePROMs comprised the 4-item Morisky-Green-Levine questionnaire and an adapted version of the Haynes-Sackett questionnaire. The Simplified Medication Adherence Questionnaire (SMAQ) was also applied on-site. Three consecutive medication nonadherence assessments were performed by a transplant pharmacist. To improve medication nonadherence, theory-based interventions were delivered in a 1-month period. Patient satisfaction was assessed by a semiquantitative Web-based survey at the end of the study. Results We included 31 early stage HTxR (age: mean 54 years, SD 12 years), and 71% (22/31) of them were men. The HTxR were taking a mean 13 (SD 4; range 7-18) drugs per day. A total of 42% (13/31) of patients were unaware of the consequences of medication nonadherence, and 39% (12/31) of patients were nonadherent to immunosuppressive treatment. The content validity measure showed excellent levels of expert panel agreement for the Haynes-Sacket (14/14, 100%) and Morisky-Green-Levine (13/14, 93%) questionnaires. SMAQ and Morisky-Green-Levine ePROMs showed similar measurement domains (convergent validity, phi=0.6, P<.001), which, as expected, differed from Haynes-Sackett ePROMs (divergent validity, phi=0.3, P=.12). Reliability assessment revealed a very strong association between ePROM and on-site PROMs (phi>0.7, P<.001). Reproducibility was moderate (Haynes-Sackett κ=0.6, P<.002) or poor (Morisky-Green-Levine κ=0.3, P=.11) because of unexpected improved medication adherence rates during the test-retest period. According to responsiveness, the theory-based multifaceted intervention program improved medication nonadherence by 16% to 26% (P<.05). A burden analysis showed that ePROMs could potentially overcome traditional on-site limitations (eg, automatic recording of ePROM responses in the hospital information system). The mean score for overall patient satisfaction with the mHeart approach was 9 (SD 2; score range: 0-10). All 100% (29/29) of patients surveyed reported that they would recommend the mHeart platform to other HTxR. Conclusions ePROMs adhered to the quality standards and successfully identified medication nonadherence in the HTx population, supporting their widespread use. The theory-based intervention program showed a promising improvement in medication adherence rates and produced excellent patient satisfaction and usability scores in HTxR.
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Affiliation(s)
- Mar Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Eulalia Roig
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain.,Medicine Department, Autonomous University of Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Sonia Mirabet
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Jan T De Pourcq
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Irene Conejo
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Anna Feliu
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Vicens Brossa
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Laura Lopez
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
| | - Andreu Ferrero-Gregori
- Institute of Biomedical Research IIB Sant Pau, Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - Anna Barata
- Moffitt Cancer Center, Florida, FL, United States
| | - M Antonia Mangues
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain
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22
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Villeneuve C, Rousseau A, Rerolle JP, Couzi L, Kamar N, Essig M, Etienne I, Westeel PF, Büchler M, Esposito L, Thierry A, Marquet P, Monchaud C. Adherence profiles in kidney transplant patients: Causes and consequences. PATIENT EDUCATION AND COUNSELING 2020; 103:189-198. [PMID: 31447197 DOI: 10.1016/j.pec.2019.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Adherence is a dynamic phenomenon and a critical determinant of transplant patients outcome. The objective of this longitudinal study was to explore adherence in kidney transplant patients followed-up for up to three years after transplantation. METHODS Adherence was repeatedly estimated using the Morisky-Green-Levine 4-Item Medication Adherence Scale, in two successive cohorts of 345 (EPIGREN) and 367 (EPHEGREN) kidney transplant recipients. Mixed effect modeling with latent processes and latent classes was used to describe adherence time-profiles. RESULTS Two latent classes were identified. The adherent class represented 85% of the patients. Patients of the poorer-adherence class displayed a lower adherence at one month (p<10-3), which worsened over time. Good adherence was associated with age >50 years, fewer depression episodes (5% vs. 13%, p = 0.001) and a better mental health component of quality of life (MCS-SF36 47 ± 11 vs. 41 ± 13, p = 0.015). Survival without acute rejection episodes was longer in the adherent class (p = 0.004). CONCLUSIONS The risk of poor adherence in renal transplant patients can be detected as early as one month post-transplantation, using appropriate and easy tools adapted to routine monitoring. PRACTICE IMPLICATIONS An early focus on vulnerable patients should allow putting into place actions in order to reduce the risk of poor outcome related to poor adherence.
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Affiliation(s)
- Claire Villeneuve
- CHU Limoges, Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, F-87000 Limoges, France; INSERM, UMR-1248, F-87000 Limoges, France.
| | - Annick Rousseau
- INSERM, UMR-1248, F-87000 Limoges, France; FHU SUPORT, Limoges, F-87000, France; Univ Limoges, Faculty of Pharmacy, Department of Biophysics, F-87000 Limoges, France
| | - Jean-Phillipe Rerolle
- INSERM, UMR-1248, F-87000 Limoges, France; FHU SUPORT, Limoges, F-87000, France; Department of Nephrology, Dialysis and Transplantation, F-87000, Limoges, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis, Centre Hospitalier Universitaire (CHU) Pellegrin, Bordeaux, France; CNRS-UMR 5164 Immuno ConcEpT, Bordeaux University, Bordeaux, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Toulouse, Toulouse, France; Université Paul Sabatier, Toulouse, France; INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France
| | - Marie Essig
- INSERM, UMR-1248, F-87000 Limoges, France; FHU SUPORT, Limoges, F-87000, France; Department of Nephrology, Dialysis and Transplantation, F-87000, Limoges, France; Univ Limoges, Faculty of Medicine, F-87000 Limoges, France
| | - Isabelle Etienne
- Service de Nephrologie, Rouen University Hospital, Rouen, France
| | - Pierre-Francois Westeel
- Department of Nephrology and Kidney Transplantation, University Hospital of Amiens, Amiens, France
| | - Mathias Büchler
- FHU SUPORT, Limoges, F-87000, France; Department of Nephrology and Kidney Transplantation, University Hospital of Tours, Tours, France; François Rabelais University, EA 4245 Tours, France
| | - Laure Esposito
- Department of Nephrology and Organ Transplantation, CHU Toulouse, Toulouse, France
| | - Antoine Thierry
- FHU SUPORT, Limoges, F-87000, France; CHU Poitiers, Department of Nephrology, Dialysis and Transplantation, F-86000 Poitiers, France
| | - Pierre Marquet
- CHU Limoges, Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, F-87000 Limoges, France; INSERM, UMR-1248, F-87000 Limoges, France; FHU SUPORT, Limoges, F-87000, France; Univ Limoges, Faculty of Medicine, F-87000 Limoges, France
| | - Caroline Monchaud
- CHU Limoges, Department of Pharmacology, Toxicology and Centre of Pharmacovigilance, F-87000 Limoges, France; INSERM, UMR-1248, F-87000 Limoges, France; FHU SUPORT, Limoges, F-87000, France
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23
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Jannuzzi FF, Cornélio ME, São-João TM, Gallani MC, Godin G, Rodrigues RCM. Psychosocial determinants of adherence to oral antidiabetic medication among people with type 2 diabetes. J Clin Nurs 2019; 29:909-921. [PMID: 31856319 DOI: 10.1111/jocn.15149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/25/2019] [Accepted: 06/30/2019] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to identify the psychosocial determinants of adherence to oral antidiabetic medication, according to the Theory of Planned Behaviour (TPB). BACKGROUND Appropriate adherence to oral antidiabetic medication contributes to long-term glycaemic control. However, glycaemic control is often poor in people with type 2 diabetes, mainly due to the poor adherence to oral antidiabetic agents. DESIGN Prospective study with 2 waves of data collection, based on STROBE checklist was conducted. One hundred and fifty-seven adults with type 2 diabetes, in chronic use of oral antidiabetic agents, composed the sample. At baseline, self-reported measures of medication adherence (proportion and global evaluation of adherence) and of metabolic control (glycated haemoglobin) of diabetes were obtained. METHODS The TPB main constructs (attitude, subjective norm and perceived control) and related beliefs were measured. Adherence and metabolic control measurements were obtained in a two-month follow-up (n = 157). RESULTS Attitude and subjective norm, together, explained 30% of the variability in intention; their underlying belief-based measures (behavioural and normative beliefs) explained 28% of the variability in intention. In addition, intention predicted behaviour at follow-up. However, when added to the prediction model, past behaviour was the only explanatory factor of adherence behaviour. CONCLUSION Adherence behaviour to oral antidiabetic medication was predicted by intention, which, in turn, was determined by attitude and subjective norm. In order to promote adherence to oral antidiabetic agents, health professionals should include motivational strategies as well as strategies targeted to attitude and subjective norm when designing interventions. RELEVANCE TO CLINICAL PRACTICE The nonadherence to antidiabetic medication contributes to lack of control of diabetes and ensuing complications. The comprehension of the factors explaining the variability in medication adherence can inform the design of theory-based interventions aimed at promoting this behaviour.
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Affiliation(s)
| | | | | | | | - Gaston Godin
- Faculté des sciences infirmières, Université Laval, Québec City, Québec, Canada
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24
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Gomis-Pastor M, Roig Mingell E, Mirabet Perez S, Brossa Loidi V, Lopez Lopez L, Diaz Bassons A, Aretio Pousa A, Feliu Ribera A, Ferrero-Gregori A, Guirado Perich L, Mangues Bafalluy MA. Multimorbidity and medication complexity: New challenges in heart transplantation. Clin Transplant 2019; 33:e13682. [PMID: 31368585 DOI: 10.1111/ctr.13682] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/30/2019] [Accepted: 07/29/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Multimorbidity and therapeutic complexity are a recognized problem in the heart transplant (HTx) population. However, little is known about how best to quantify this complexity or the strategies that could reduce its burden. METHODS This single-center, observational study included adult heart transplant recipients (HTxR) >1.5 years from transplant. We assessed multimorbidity (>2 comorbidities) and the patient-level Medication Regimen Complexity Index Spanish version (pMRCI-S) score. We also analyzed the independent predictors of pMRCI-S and the impact of the index score on specific clinical variables. RESULTS We included 135 chronic-stage HTxR. Comorbidities significantly increased after HTx (6 ± 3 vs 2 ± 2, P-value < .001). Patients took 12 ± 3 chronic drugs/d, 58% of them to treat comorbidities. The mean total pMRCI-S score was 42 ± 11, higher than in several other chronic diseases. The medication category drugs to treat comorbidities predicted a higher total pMRCI-S score (OR = 3.12, 95% CI 2.8-3.43, P-value < .001). Therapeutic complexity after HTx had an impact on solid malignancies (OR = 1.1, 95% CI 1.02-1.18, P-value = .02) and renal function (OR=-0.81, 95% CI -1.21-(-0.42), P-value < .001). CONCLUSIONS The multimorbidity and pMRCI-S scores obtained in HTx population were worrisomely high. The pMRCI score is a sensitive method that allows identification of the factors determining therapeutic complexity after HTx and selection of strategies to reduce pMRCI-S values.
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Affiliation(s)
- Mar Gomis-Pastor
- Heart Transplant Unit and Pharmacy Department, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain.,UAB Medicine Department, Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Eulalia Roig Mingell
- UAB Medicine Department, Autonomous University of Barcelona (UAB), Barcelona, Spain.,Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain
| | - Sonia Mirabet Perez
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain
| | - Vicente Brossa Loidi
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain
| | - Laura Lopez Lopez
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain
| | - Alba Diaz Bassons
- Pharmacy Department, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain
| | - Ana Aretio Pousa
- Pharmacy Department, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain
| | - Anna Feliu Ribera
- Pharmacy Department, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain
| | - Andreu Ferrero-Gregori
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institute of Biomedical Research IIB Sant Pau, CIBERCV, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluís Guirado Perich
- UAB Medicine Department, Autonomous University of Barcelona (UAB), Barcelona, Spain.,Nephrology Department and Renal Transplant Unit, Nephrology Department, Fundació Puigvert, Barcelona, Spain
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25
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Tang E, Bansal A, Famure O, Keszei A, Novak M, Kim SJ, Mucsi I. Substance use in kidney transplant candidates and its impact on access to kidney transplantation. Clin Transplant 2019; 33:e13565. [PMID: 31002182 DOI: 10.1111/ctr.13565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/20/2019] [Accepted: 04/07/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Due to the increasing public acceptance of substance use, it is important to understand the association between substance use and access to kidney transplant and its outcomes. Here, we assess the sociodemographic predictors of substance use and the association between substance use and KT access. METHODS Predictors of substance use were examined using a multivariable-adjusted multinomial logistic regression. The association between current substance use (tobacco and drug) and time from referral to listing or receipt of a KT was examined using Cox proportional hazards models. RESULTS Of 2346 patients, the prevalence of current substance use was 17%. Predictors of current tobacco use were younger age, male sex, Caucasian ethnicity, being unemployed, and unmarried. Predictors of current drug use were younger age, male sex, Caucasian ethnicity, a history of non-adherence, and a history of mental health disorder. Patients with tobacco use had a decreased likelihood of being cleared for KT (hazard ratio [HR]:0.83[0.70, 0.99]) and receiving a KT (HR:0.80 [0.66, 0.96]). No association was seen in this sample for patients with drug use (HR:0.88 [0.69, 1.11] for being cleared for KT and 0.88 [0.69, 1.14] for KT, respectively). CONCLUSIONS Tobacco use was associated with a decreased likelihood of access to KT whereas there was no statistically significant difference in access to KT between patients with or without drug use.
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Affiliation(s)
- Evan Tang
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Aarushi Bansal
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Olusegun Famure
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andras Keszei
- Center for Translational & Clinical Research Aachen (CTC-A), Uniklinik RWTH Aachen University, Aachen, Germany
| | - Marta Novak
- Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - S Joseph Kim
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Istvan Mucsi
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
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26
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Drangsholt SH, Cappelen UW, von der Lippe N, Høieggen A, Os I, Brekke FB. Beliefs about medicines in dialysis patients and after renal transplantation. Hemodial Int 2019; 23:117-125. [DOI: 10.1111/hdi.12717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/03/2018] [Accepted: 10/15/2018] [Indexed: 12/22/2022]
Affiliation(s)
| | | | - Nanna von der Lippe
- Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Nephrology; Oslo University Hospital Ullevål; Oslo Norway
| | - Aud Høieggen
- Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Nephrology; Oslo University Hospital Ullevål; Oslo Norway
| | - Ingrid Os
- Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Nephrology; Oslo University Hospital Ullevål; Oslo Norway
| | - Fredrik B. Brekke
- Sanitary Battalion; Brigade North, Norwegian Armed Forces; Setermoen Norway
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27
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Zhang M, Zhou H, Nelson RS, Han Y, Wang Y, Xiang H, Cai J, Zhang J, Yuan Y. Prevalence and Risk Factors of Immunosuppressant Nonadherence in Heart Transplant Recipients: A Single-Center Cross-Sectional Study. Patient Prefer Adherence 2019; 13:2185-2193. [PMID: 31908425 PMCID: PMC6930119 DOI: 10.2147/ppa.s223837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/09/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Immunosuppressant 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. METHODS Adult 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. RESULTS A 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). CONCLUSIONS Heart 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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Affiliation(s)
- Min Zhang
- Department of Pharmacy, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing400014, People’s Republic of China
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan430022, People’s Republic of China
| | - Hong Zhou
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan430022, People’s Republic of China
| | - Ryan S Nelson
- Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL33612, USA
| | - Yong Han
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan430022, People’s Republic of China
| | - Yirong Wang
- Department of Pharmacy, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing400014, People’s Republic of China
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan430022, People’s Republic of China
| | - Hongping Xiang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan430022, People’s Republic of China
| | - Jie Cai
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan430022, People’s Republic of China
| | - Jing Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan430022, People’s Republic of China
| | - Yonghua Yuan
- Department of Pharmacy, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing400014, People’s Republic of China
- Correspondence: Yonghua Yuan Department of Pharmacy, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, No. 136 Zhongshan Er Road, Yuzhong District, Chongqing400014, People’s Republic of ChinaTel +86-023-68485161 Email
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Drick N, Seeliger B, Fuge J, Tudorache I, Greer M, Welte T, Haverich A, Gottlieb J. Self-reported non-adherence to immunosuppressive medication in adult lung transplant recipients-A single-center cross-sectional study. Clin Transplant 2018; 32:e13214. [DOI: 10.1111/ctr.13214] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Nora Drick
- Department of Respiratory Medicine; Hannover Medical School; Hannover Germany
| | - Benjamin Seeliger
- Department of Respiratory Medicine; Hannover Medical School; Hannover Germany
| | - Jan Fuge
- Member of the German Center for Lung Research (DZL); Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH); Hannover Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplantation and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Mark Greer
- Department of Respiratory Medicine; Hannover Medical School; Hannover Germany
- Member of the German Center for Lung Research (DZL); Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH); Hannover Germany
| | - Tobias Welte
- Department of Respiratory Medicine; Hannover Medical School; Hannover Germany
- Member of the German Center for Lung Research (DZL); Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH); Hannover Germany
| | - Axel Haverich
- Member of the German Center for Lung Research (DZL); Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH); Hannover Germany
- Department of Cardiothoracic, Transplantation and Vascular Surgery; Hannover Medical School; Hannover Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine; Hannover Medical School; Hannover Germany
- Member of the German Center for Lung Research (DZL); Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH); Hannover Germany
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29
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Ladin K, Daniels A, Osani M, Bannuru RR. Is social support associated with post-transplant medication adherence and outcomes? A systematic review and meta-analysis. Transplant Rev (Orlando) 2018; 32:16-28. [PMID: 28495070 PMCID: PMC5658266 DOI: 10.1016/j.trre.2017.04.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/23/2017] [Accepted: 04/18/2017] [Indexed: 11/18/2022]
Abstract
Although social support is used to determine transplant eligibility, the relationship between social support, medication adherence, and survival among transplant recipients remains unclear. We estimated the relationship between social support and post-transplant medication adherence and outcomes using 10 electronic databases from inception to January 2016. Study quality was assessed and all review stages were conducted independently by 2 reviewers. Systematic review and meta-analysis were conducted. Thirty-two studies (9102 participants) met inclusion criteria: 21 assessed medication adherence (5197 participants), and 13 assessed clinical outcomes (3905 participants). Among high quality studies, neither social support nor marital status was predictive of medication adherence or post-transplant outcomes. Social support was not associated with medication adherence. It was associated with superior post-transplant outcomes, but the relationship was not significant among high quality studies. Compared to unmarried recipients, married recipients were more likely to adhere to medication post-transplant, but this relationship was not significant among high quality studies. Marital status was not significantly associated with transplant success. Social support is weakly and inconsistently associated with post-transplant adherence and outcomes. Larger prospective studies using consistent and validated measures are needed to justify the use of inadequate social support as a contraindication to transplantation.
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Affiliation(s)
- Keren Ladin
- Department of Occupational Therapy, Tufts University, Medford, MA; Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA; Research on Ethics, Aging, and Community Health (REACH Lab).
| | - Alexis Daniels
- Department of Occupational Therapy, Tufts University, Medford, MA; Research on Ethics, Aging, and Community Health (REACH Lab)
| | - Mikala Osani
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Tufts Medical Center, Boston, MA
| | - Raveendhara R Bannuru
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Tufts Medical Center, Boston, MA
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30
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Vankova B, Mala-Ladova K, Kubena AA, Maly J, Sulkova SD. Immunosuppressive therapy related adherence, beliefs and self-management in kidney transplant outpatients. Patient Prefer Adherence 2018; 12:2605-2613. [PMID: 30584284 PMCID: PMC6287542 DOI: 10.2147/ppa.s184166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Kidney transplant (KTx) recipients should strictly adhere to their lifelong complex therapeutic regimen, and any barriers to medication adherence can weaken correct patient behavior. This study aimed to determine the adherence to immunosuppressive therapy (IS) in KTx adult outpatients in the Czech Republic, and attempted to gain a greater insight into their attitudes toward IS and self-management tasks. MATERIALS AND METHODS Pharmacist-led structured interviews were conducted to assess self-reported adherence to IS using the Czech version of the Medication Adherence Report Scale, in the context of attitudes toward IS in terms of necessity and concern scale of the Beliefs about Medicines Questionnaire. A specific questionnaire was developed to target IS self-management tasks. Medication records were also reviewed for IS serum levels, reflecting direct adherence measurement. Descriptive statistics were used to calculate adherence and self-management variables, and were analyzed by univariate and multivariate correlations, including the decision-tree method. RESULTS The interview was completed by 211 (male 123; mean age 55.0±12.4 years, mean time 6.6±5.9 years after KTx) of the total of 235 patients. Full adherence to IS was reported by 173 (82.0%) patients. Most of them had IS serum levels within the therapeutic range, however, cyclosporine was associated with the highest variability (P<0.001). Non-adherence and concerns increased over time after KTx (P<0.05). Despite the more common unintentional non-adherence (P<0.001), relatively high concerns signified the risk of not taking IS as prescribed. Concerns also correlated with the perception of impaired health status (P<0.01), as well as the occurrence of IS-related adverse effects (P<0.001). The patients' awareness of their therapy was insufficient, and main gaps in self-management comprised inadequate sun protection, incorrect administration of IS, and unfamiliarity with the IS name, or their indications. CONCLUSION Although self-reported adherence to IS therapy was satisfactory, the comprehensive evaluation enabled the detection of greater concerns about IS, as well as underestimated self-management tasks that posttransplant interventions should target in the future.
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Affiliation(s)
- Barbora Vankova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic,
| | - Katerina Mala-Ladova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic,
| | - Ales Antonin Kubena
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic,
| | - Josef Maly
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Hradec Králové, Czech Republic,
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31
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Medication adherence among allogeneic hematopoietic stem cell transplant recipients: a pilot single-center study. Bone Marrow Transplant 2017; 53:231-233. [PMID: 29155420 DOI: 10.1038/bmt.2017.233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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32
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Belaiche S, Décaudin B, Dharancy S, Gautier S, Noel C, Odou P, Hazzan M. Factors associated with the variability of calcineurin inhibitor blood levels in kidney recipients grafted for more than 1 year. Fundam Clin Pharmacol 2017; 32:88-97. [DOI: 10.1111/fcp.12328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/06/2017] [Accepted: 10/10/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Stéphanie Belaiche
- Institut de pharmacie; CHU Lille; F-59000 Lille France
- EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées; Université Lille; F-59000 Lille France
| | - Bertrand Décaudin
- Institut de pharmacie; CHU Lille; F-59000 Lille France
- EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées; Université Lille; F-59000 Lille France
| | - Sébastien Dharancy
- Service des Maladies de l'appareil Digestif et de la Nutrition; CHU Lille; F-59000 Lille France
- Inserm U995 - LIRIC - Lille Inflammation Research International Center; Université Lille; F-59000 Lille France
| | - Sophie Gautier
- Département de pharmacologie; CHU Lille; F-59000 Lille France
- Inserm, U1171; Université Lille; F-59000 Lille France
| | - Christian Noel
- Service de Néphrologie; CHU Lille; F-59000 Lille France
- Inserm U995 - LIRIC - Lille Inflammation Research International Center; Université Lille; F-59000 Lille France
| | - Pascal Odou
- Institut de pharmacie; CHU Lille; F-59000 Lille France
- EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées; Université Lille; F-59000 Lille France
| | - Marc Hazzan
- Service de Néphrologie; CHU Lille; F-59000 Lille France
- Inserm U995 - LIRIC - Lille Inflammation Research International Center; Université Lille; F-59000 Lille France
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Mehta P, Steinberg EA, Kelly SL, Buchanan C, Rawlinson AR. Medication adherence among adolescent solid-organ transplant recipients: A survey of healthcare providers. Pediatr Transplant 2017; 21. [PMID: 28670855 DOI: 10.1111/petr.13018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2017] [Indexed: 01/14/2023]
Abstract
The aim of this study was to assess healthcare provider perspectives on barriers to medication adherence and to discover recommendations for interventions among providers of pediatric solid-organ transplant patients. An anonymous online survey was administered to a multidisciplinary pool of pediatric transplant providers from February 2015 to March 2016. It consisted of 15 questions regarding transplant providers' attitudes, clinical practice, and beliefs pertaining to medication adherence among teenage solid-organ transplant recipients. Data were analyzed using descriptive statistics. Responses to open-ended questions were coded and categorized into themes. One hundred ten surveys were completed by providers specializing in pediatric heart, kidney, liver, lung, and/or intestinal transplantation. Commonly cited reasons for poor adherence were forgetting/poor planning (94%), the desire to be normal (86%), lack of support (86%), and poor parental monitoring (79%). Suggestions to improve adherence included increasing peer and family support, providing education, and incorporating technology into adherence regimens. Barriers to adherence in transplant patients are recognized by providers and are both similar to and disparate from patient and family identified barriers published in the literature. Providers recognize the importance of education, social support, and technologically driven interventions on improving outcomes in the transplant population.
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Affiliation(s)
- Pooja Mehta
- Digestive Health Institute, Children's Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elizabeth A Steinberg
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah L Kelly
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cindy Buchanan
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
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Villeneuve C, Woillard JB, Knoop C, Essig M, Etienne I, Epailly E, Pison C, Debette-Gratien M, Marquet P, Monchaud C. Evaluation of Experiences with Immunosuppressive Drugs in Transplantation: Validation of the MESI Scale in French. Pharmaceut Med 2017. [DOI: 10.1007/s40290-017-0207-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hu L, Lingler JH, Sereika SM, Burke LE, Malchano DK, DeVito Dabbs A, Dew MA. Nonadherence to the medical regimen after lung transplantation: A systematic review. Heart Lung 2017; 46:178-186. [DOI: 10.1016/j.hrtlng.2017.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 01/09/2023]
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36
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Belaiche S, Décaudin B, Dharancy S, Noel C, Odou P, Hazzan M. Factors relevant to medication non-adherence in kidney transplant: a systematic review. Int J Clin Pharm 2017; 39:582-593. [PMID: 28374343 DOI: 10.1007/s11096-017-0436-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 02/06/2017] [Indexed: 01/14/2023]
Abstract
Background Medication non-adherence is a major issue after transplant that can lead to misdiagnosis, rejection, poor health affecting quality of life, graft loss or death. Several estimations of adherence and related factors have previously been described but conclusions leave doubt as to the most accurate assessment method. Aim of the review To identify the factors most relevant to medication non-adherence in kidney transplant in current clinical practice. Method This systematic review is registered in the PROSPERO data base and follows the Prisma checklist. Articles in English in three databases from January 2009 to December 2014 were analysed. A synthesis was made to target adherence assessment methods, their prevalence and significance. Results Thirty-seven studies were analysed rates of non-adherence fluctuating from 1.6 to 96%. Assessment methods varied from one study to another, although self-reports were mainly used. It appears that youth (≤50 years old), male, low social support, unemployment, low education, ≥3 months post graft, living donor, ≥6 comorbidities, ≥5 drugs/d, ≥2 intakes/d, negative beliefs, negative behavior, depression and anxiety were the factors significantly related to non-adherence. Conclusion As there are no established guidelines, consideration should be given to more than one approach to identify medication non-adherence although self-reports should remain the cornerstone of adherence assessment.
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Affiliation(s)
- Stephanie Belaiche
- Institut de pharmacie, CHU Lille, 59000, Lille, France. .,EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Univ. Lille, 59000, Lille, France.
| | - Bertrand Décaudin
- Institut de pharmacie, CHU Lille, 59000, Lille, France.,EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Univ. Lille, 59000, Lille, France
| | - Sébastien Dharancy
- Service des Maladies de l'appareil digestif et de la Nutrition, CHU Lille, 59000, Lille, France.,Inserm U995 - LIRIC - Lille Inflammation Research International Center, Univ. Lille, 59000, Lille, France
| | - Christian Noel
- Service de Néphrologie, CHU Lille, 59000, Lille, France.,Inserm U995 - LIRIC - Lille Inflammation Research International Center, Univ. Lille, 59000, Lille, France
| | - Pascal Odou
- Institut de pharmacie, CHU Lille, 59000, Lille, France.,EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Univ. Lille, 59000, Lille, France
| | - Marc Hazzan
- Service de Néphrologie, CHU Lille, 59000, Lille, France.,Inserm U995 - LIRIC - Lille Inflammation Research International Center, Univ. Lille, 59000, Lille, France
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Schold JD, Phelan MP, Buccini LD. Utility of Ecological Risk Factors for Evaluation of Transplant Center Performance. Am J Transplant 2017; 17:617-621. [PMID: 27696682 DOI: 10.1111/ajt.14074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 01/25/2023]
Abstract
There is substantial evidence across different healthcare contexts that social determinants of health are strongly associated with morbidity and mortality in the United States. These factors, including socioeconomic status, behavior and environmental risks, education, social support, healthy food, and access to healthcare also vary widely by region and individual communities. One of the implications of heterogeneity in these risks is the potential impact on measured quality of healthcare providers. In particular, there is concern that providers treating disproportionally vulnerable communities may be disadvantaged by lack of risk adjustment for these factors that affect health but not indicators of quality of care. Recently, the National Quality Forum has endorsed risk adjustment for sociodemographic characteristics based on these concerns. These issues are salient to transplant programs since social determinants of health impact transplant patient outcomes and vary by region. In this viewpoint, we argue that integration of ecological (area-level) factors in risk adjustment models used to assess transplant center quality should be strongly considered. We believe this reform could be accomplished rapidly, would attenuate disparities in access to care by reducing disincentives to treat patients from vulnerable communities, and improve risk adjustment and calibration of models used for center evaluations.
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Affiliation(s)
- J D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH
| | - M P Phelan
- Department of Emergency Medicine, Cleveland Clinic, Cleveland, OH
| | - L D Buccini
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH.,Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
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Zanetti-Yabur A, Rizzo A, Hayde N, Watkins AC, Rocca JP, Graham JA. Exploring the usage of a mobile phone application in transplanted patients to encourage medication compliance and education. Am J Surg 2017; 214:743-747. [PMID: 28256241 DOI: 10.1016/j.amjsurg.2017.01.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/11/2017] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Medication non-adherence in transplant patients is a grave problem that results in increased rejection episodes, graft loss and significant morbidity. METHODS The efficacy of users and non-users of a mobile phone application (mobile app) in promoting medication adherence was investigated. The Beliefs about Medicine Questionnaire (BMQ) and Morisky Medication Adherence Scale (MMAS-8) were used in these cohorts to assess the predilection for poor adherence. Serum tacrolimus, creatinine levels, and rejection episodes were also recorded. Lastly, the patients were tested on their recall of their immunosuppression. RESULTS Overall, patients had extremely negative beliefs about medication reflected in their tendency toward higher predicted rates of non-adherence. Interestingly, though not significant, app users had higher rates of medication recollection. CONCLUSIONS The high-risk nature of this population demands efforts to abrogate non-adherence. Caregivers are charged with the responsibility to offer patients a feasible option to safeguard treatment compliance. Mobile apps are a potentially powerful tool, which can be used to decrease non-adherence.
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Affiliation(s)
- Alana Zanetti-Yabur
- Montefiore - Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA.
| | - Amanda Rizzo
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nicole Hayde
- Division of Pediatric Nephrology, Montefiore Medical Center, Bronx, NY, USA
| | - Anthony C Watkins
- New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Juan P Rocca
- Montefiore - Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Jay A Graham
- Montefiore - Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
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39
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Jones J, Rosaasen N, Taylor J, Mainra R, Shoker A, Blackburn D, Wilson J, Mansell H. Health Literacy, Knowledge, and Patient Satisfaction Before Kidney Transplantation. Transplant Proc 2016; 48:2608-2614. [DOI: 10.1016/j.transproceed.2016.07.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/26/2016] [Indexed: 10/20/2022]
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40
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Doyle IC, Maldonado AQ, Heldenbrand S, Tichy EM, Trofe-Clark J. Nonadherence to therapy after adult solid organ transplantation: A focus on risks and mitigation strategies. Am J Health Syst Pharm 2016; 73:909-20. [PMID: 27189855 DOI: 10.2146/ajhp150650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Ian C Doyle
- School of Pharmacy, Pacific University, Hillsboro, OR.
| | | | - Seth Heldenbrand
- Office of Experiential Education, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Eric M Tichy
- Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT
| | - Jennifer Trofe-Clark
- Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, PARenal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Abstract
PURPOSE OF REVIEW Psychiatrists and other mental health professionals typically assist with evaluating and treating psychiatric and behavioral issues in transplant candidates, recipients, and living organ donors. In this review recent findings on specific psychiatric issues in adult solid organ transplant candidates and recipients, as well as living donors are discussed as well as their relevance to clinical practice. RECENT FINDINGS Patients with complex mental health and addiction histories can have outcomes similar to patients without these disorders but may require specialized pretransplant preparation or posttransplant interventions to optimize their outcomes. Specific attention to the preparation and wellbeing of living donors is needed. SUMMARY As transplant programmes increasingly consider patients with complex mental health histories, psychiatrists, and mental health professionals evaluating and treating these patients need to consider plans for early identification and treatment. Psychiatric care provided across the preoperative to postoperative periods will best address the longitudinal care needs of patients with mental health disorders. Abstinence from substances and complete adherence to medical directives provides the best chance for optimal outcomes. Treatment of depression may improve transplant outcomes. Research is needed to identify effective interventions and the best strategies to engage patients to improve adherence. VIDEO ABSTRACT http://links.lww.com/YCO/A30.
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Abstract
PURPOSE OF REVIEW Nonadherence is a major problem in heart transplantation (htx) and a challenge for clinical practice and research. In heart transplant recipients, nonadherence could cause chronic rejection of the transplanted heart followed by difficult clinical course and/or death of the patient. RECENT FINDINGS Main topics are the relationship between psychological aspects and adherence, risk factors and prediction of nonadherence, strategies for improving adherence like single-dose immunosuppressant therapy and follow-up studies. SUMMARY There is a lack of behavioral intervention studies. So-called targeted interventions should be defined for clinical practice and research with randomized controlled studies.
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Guénette L, Lauzier S, Guillaumie L, Giguère G, Grégoire JP, Moisan J. Patients' beliefs about adherence to oral antidiabetic treatment: a qualitative study. Patient Prefer Adherence 2015; 9:413-20. [PMID: 25792814 PMCID: PMC4362977 DOI: 10.2147/ppa.s78628] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to elicit patients' beliefs about taking their oral antidiabetic drugs (OADs) as prescribed to inform the development of sound adherence-enhancing interventions. METHODS A qualitative study was performed. Adults with type 2 diabetes who had been taking an OAD for >3 months were solicited to participate in one of six focus groups. Discussions were facilitated using a structured guide designed to gather beliefs related to important constructs of the theory of planned behavior. Four coders using this theory as the theoretical framework analyzed the videotaped discussions. RESULTS Forty-five adults participated. The most frequently mentioned advantages for OAD-taking as prescribed were to avoid long-term complications and to control glycemia. Family members were perceived as positively influential. Carrying the OAD at all times, having the OAD in sight, and having a routine were important facilitating factors. Being away from home, not accepting the disease, and not having confidence in the physician's prescription were major barriers to OAD-taking. CONCLUSION This study elicited several beliefs regarding OAD-taking behavior. Awareness of these beliefs may help clinicians adjust their interventions in view of their patients' beliefs. Moreover, this knowledge is crucial to the planning, development, and evaluation of interventions that aim to improve medication adherence.
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Affiliation(s)
- Line Guénette
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
- Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
- CHU de Québec Research Center, Population Health and Optimal Practices Research Unit, Quebec City, QC, Canada
| | - Sophie Lauzier
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
- Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
- CHU de Québec Research Center, Population Health and Optimal Practices Research Unit, Quebec City, QC, Canada
| | - Laurence Guillaumie
- Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
- CHU de Québec Research Center, Population Health and Optimal Practices Research Unit, Quebec City, QC, Canada
- Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - Gabriel Giguère
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
| | - Jean-Pierre Grégoire
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
- Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
- CHU de Québec Research Center, Population Health and Optimal Practices Research Unit, Quebec City, QC, Canada
| | - Jocelyne Moisan
- Faculty of Pharmacy, Laval University, Quebec City, QC, Canada
- Chair on Adherence to Treatments, Laval University, Quebec City, QC, Canada
- CHU de Québec Research Center, Population Health and Optimal Practices Research Unit, Quebec City, QC, Canada
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Massey EK, Tielen M, Laging M, Timman R, Beck DK, Khemai R, van Gelder T, Weimar W. Discrepancies Between Beliefs and Behavior. Transplantation 2015; 99:375-80. [DOI: 10.1097/tp.0000000000000608] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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