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Denhaerynck K, Berger Wermuth G, Dobbels F, Berben L, Russell CL, De Geest S. International Variability of Barriers to Adherence to Immunosuppressive Medication in Adult Heart Transplant Recipients. A Secondary Data Analysis of the BRIGHT Study. Transpl Int 2024; 37:12874. [PMID: 39267616 PMCID: PMC11391111 DOI: 10.3389/ti.2024.12874] [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: 02/19/2024] [Accepted: 08/05/2024] [Indexed: 09/15/2024]
Abstract
Non-adherence to immunosuppressive medication among transplant patients is associated with poor clinical outcomes and higher economic costs. Barriers to immunosuppressives are a proximal determinant of non-adherence. So far, international variability of barriers to adherence in transplantation has not been studied. As part of the cross-sectional multi-country and multi-center BRIGHT study, barriers to adherence were measured in 1,382 adult heart transplant recipients of 11 countries using the 28-item self-report questionnaire "Identifying Medication Adherence Barriers" (IMAB). Barriers were ranked by their frequency of occurrence for the total sample and by country. Countries were also ranked the by recipients' total number of barriers. Intra-class correlations were calculated at country and center level. The five most frequently mentioned barriers were sleepiness (27.1%), being away from home (25.2%), forgetfulness (24.5%), interruptions to daily routine (23.6%) and being busy (22.8%), fairly consistently across countries. The participants reported on average three barriers, ranging from zero up to 22 barriers. The majority of the variability among reported barriers frequency was situated at the recipient level (94.8%). We found limited international variability in primarily person-level barriers in our study. Understanding of barriers in variable contexts guides intervention development to support adherence to the immunosuppressive regimen in real-world settings.
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Affiliation(s)
- Kris Denhaerynck
- Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Gabriele Berger Wermuth
- Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Lut Berben
- Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Cynthia L Russell
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas, MO, United States
| | - Sabina De Geest
- Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
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2
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Gyngell C, Munsie M, Fujita M, Thiessen C, Savulescu J, Konstantinov IE. Ethical analysis of the first porcine cardiac xenotransplantation. JOURNAL OF MEDICAL ETHICS 2024; 50:363-367. [PMID: 37348929 DOI: 10.1136/jme-2022-108685] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/26/2023] [Indexed: 06/24/2023]
Abstract
In this article, we provide an ethical analysis of the first porcine cardiac xenotransplant, performed in Maryland, USA in early 2022. David Bennett was offered the experimental procedure after he was deemed ineligible for human heart transplantation and mechanical circulatory support, based on a history of non-compliance. It was reported that Mr Bennett's previous instances of non-compliance were for medically non-life-threatening conditions years earlier, where the risks of non-compliance were not as high. We argue that, in Mr Bennett's case, a history of non-compliance in a different context, should not necessarily rule him ineligible for a potentially life-saving treatment now. Furthermore, using previous non-compliance to exclude individuals from donor organs may have the unintended effect of placing the burden of testing xenotransplantation on those who are already disadvantaged. We then argue that it is not enough to rely on patient consent to ethically justify xenotransplantation research. Taking a broad ethical perspective is crucial when mapping a clinical pathway for xenotransplantation.
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Affiliation(s)
- Christopher Gyngell
- Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
- Biomedical Ethics Research Group, MCRI, Parkville, Victoria, Australia
| | - Megan Munsie
- Stem Cell Ethics & Policy Group, MCRI, Parkville, Victoria, Australia
- Melbourne Medical School, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
| | - Misao Fujita
- Uehiro Research Division for iPS Cell Ethics, Kyoto University Center for iPS Cell Research and Application, Kyoto, Japan
- Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan
| | - Carrie Thiessen
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Julian Savulescu
- Biomedical Ethics Research Group, MCRI, Parkville, Victoria, Australia
- Faculty of Philosophy, University of Oxford, Oxford, UK
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Igor E Konstantinov
- Department of Paediatrics, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
- The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Heart Group, MCRI, Parkville, Victoria, Australia
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3
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Mielke J, Cajita MI, Denhaerynck K, Valenta S, Dobbels F, Russell CL, De Geest S. Trust in the Transplant Team Associated With the Level of Chronic Illness Management-A Secondary Data Analysis of the International BRIGHT Study. Transpl Int 2024; 37:11704. [PMID: 38529215 PMCID: PMC10961910 DOI: 10.3389/ti.2024.11704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/18/2024] [Indexed: 03/27/2024]
Abstract
A trustful relationship between transplant patients and their transplant team (interpersonal trust) is essential in order to achieve positive health outcomes and behaviors. We aimed to 1) explore variability of trust in transplant teams; 2) explore the association between the level of chronic illness management and trust; 3) investigate the relationship of trust on behavioral outcomes. A secondary data analysis of the BRIGHT study (ID: NCT01608477; https://clinicaltrials.gov/ct2/show/NCT01608477?id=NCT01608477&rank=1) was conducted, including multicenter data from 36 heart transplant centers from 11 countries across four different continents. A total of 1,397 heart transplant recipients and 100 clinicians were enrolled. Trust significantly varied among the transplant centers. Higher levels of chronic illness management were significantly associated with greater trust in the transplant team (patients: AOR= 1.85, 95% CI = 1.47-2.33, p < 0.001; clinicians: AOR = 1.35, 95% CI = 1.07-1.71, p = 0.012). Consultation time significantly moderated the relationship between chronic illness management levels and trust only when clinicians spent ≥30 min with patients. Trust was significantly associated with better diet adherence (OR = 1.34, 95%CI = 1.01-1.77, p = 0.040). Findings indicate the relevance of trust and chronic illness management in the transplant ecosystem to achieve improved transplant outcomes. Thus, further investment in re-engineering of transplant follow-up toward chronic illness management, and sufficient time for consultations is required.
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Affiliation(s)
- Juliane Mielke
- Department of Public Health, Faculty of Medicine, Institute of Nursing Sciences, University of Basel, Basel, Switzerland
| | - Maan Isabella Cajita
- College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Kris Denhaerynck
- Department of Public Health, Faculty of Medicine, Institute of Nursing Sciences, University of Basel, Basel, Switzerland
| | - Sabine Valenta
- Department of Public Health, Faculty of Medicine, Institute of Nursing Sciences, University of Basel, Basel, Switzerland
- Practice Development and Research Division, Medical Directorate, University Hospital Basel, Basel, Switzerland
| | - Fabienne Dobbels
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | | | - Sabina De Geest
- Department of Public Health, Faculty of Medicine, Institute of Nursing Sciences, University of Basel, Basel, Switzerland
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
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4
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Al-Saleh S, Conley S, Pace T, Insel KC. A Cross-Sectional Study of Cognitive Function, Illness Perceptions, and Immunosuppression Medication Adherence After Heart Transplantation. West J Nurs Res 2024; 46:164-171. [PMID: 38146266 DOI: 10.1177/01939459231220283] [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] [Indexed: 12/27/2023]
Abstract
BACKGROUND There are few studies that examine relationships between cognitive function, illness perceptions, and medication adherence after heart transplantation, limiting the development of effective adherence-promoting interventions. OBJECTIVE The purpose of this study was to describe relationships between cognitive function, illness perceptions, and medication adherence among heart transplant recipients. METHODS A cross-sectional, observational design was used. Measures included the telephone-Montreal Cognitive Assessment (t-MoCA©), Patient Health Questionnaire-9, Brief Test of Adult Cognition by Telephone, Basel Assessment of Adherence to Immunosuppressive Medications Scale, and the Brief Illness Perceptions Questionnaire. Descriptive statistics, point-biserial correlations, Pearson's correlations, and logistic regression were used to describe relationships. RESULTS Of the 35 participants (mean age: 61 years [SD: 10.3], 71.4% male, 71.4% white), 31.4% (n = 11) were classified as nonadherent to their immunosuppression medications. Higher immediate word recall, indicating better episodic memory (memory for autobiographical and recent events), and higher illness coherence scores were associated with not missing doses of medication. Higher t-MoCA© total scores, indicating normal cognitive function, and lower depression scores were associated with taking medications on time. More than 22% (n = 8) of participants scored less than 19 on the t-MoCA©, an indication of mild cognitive impairment. CONCLUSION Cognitive impairment may be more common among heart transplant recipients than what is currently recognized, and specific domains of cognitive function were related to medication adherence after transplantation in this study. Future studies should include longitudinal evaluations of cognitive function, depression, and medication adherence. Consideration of these relationships is needed when designing adherence-promoting interventions for this population.
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Affiliation(s)
| | | | - Thaddeus Pace
- College of Nursing, The University of Arizona, Tucson, AZ, USA
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Mols RE, Bakos I, Løgstrup BB, Horváth-Puhó E, Gustafsson F, Eiskjær H. Adherence to Pharmacotherapies After Heart Transplantation in Relation to Multimorbidity and Socioeconomic Position: A Nationwide Register-Based Study. Transpl Int 2023; 36:11676. [PMID: 37885807 PMCID: PMC10599149 DOI: 10.3389/ti.2023.11676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023]
Abstract
No studies have examined the impact of multimorbidity and socioeconomic position (SEP) on adherence to the pharmacological therapies following heart transplantation (HTx). Using nationwide Danish registers, we tested the hypothesis that multimorbidity and SEP affect treatment patterns and adherence to pharmacological therapies in first-time HTx recipients. Pharmacological management included cost-free immunosuppressants and adjuvant medical treatment (preventive and hypertensive pharmacotherapies; loop diuretics). We enrolled 512 recipients. The median (IQR) age was 51 years (38-58 years) and 393 recipients (77%) were males. In recipients with at least two chronic diseases, prevalence of treatment with antihypertensive pharmacotherapies and loop diuretics was higher. The overall prevalence of adherence to treatment with tacrolimus or mycophenolate mofetil was at least 80%. Prevalence of adherence to preventive pharmacotherapies ranged between 65% and 95% and between 66% and 88% for antihypertensive pharmacotherapies and loop diuretics, respectively. In socioeconomically disadvantaged recipients, both the number of recipients treated with and adherence to cost-free everolimus, lipid modifying agents, angiotensin-converting enzyme/angiotensin II inhibitors, calcium channel blockers, and loop diuretics were lower. In recipients with multimorbidity, prevalence of treatment with antihypertensive pharmacotherapies and loop diuretics was higher. Among socioeconomically disadvantaged recipients, both number of patients treated with and adherence to cost-free everolimus and adjuvant pharmacotherapies were lower.
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Affiliation(s)
- Rikke E. Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - István Bakos
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Brian B Løgstrup
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Finn Gustafsson
- Department of Cardiology, University Hospital of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Denhaerynck K, Dobbels F, Košťálová B, De Geest S. Psychometric Properties of the BAASIS: A Meta-analysis of Individual Participant Data. Transplantation 2023; 107:1795-1809. [PMID: 36949037 PMCID: PMC10358438 DOI: 10.1097/tp.0000000000004574] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 11/16/2022] [Accepted: 12/11/2022] [Indexed: 03/24/2023]
Abstract
BACKGROUND Nonadherence to immunosuppressives, a risk factor for poor posttransplant outcomes, can be assessed by self-report using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS). Available in written and interview versions, and previously validated on content, the BAASIS is widely used in research and clinical practice. The aim of this study was to investigate its psychometric properties. METHODS Using a literature search and our BAASIS database, this meta-analysis identified completed studies in adult transplant recipients whose data were usable to examine the BAASIS' reliability and 3 validity aspects: (1) relationships with other variables (electronic monitoring, other self-report scales, tacrolimus blood-level variability, collateral report, depressive symptoms, psycho-behavioral constructs, and interventions); (2) response processes; and (3) internal structure. Testing used random-effects logistic regressions. RESULTS Our sample included 12 109 graft recipients from 26 studies. Of these 26, a total of 20 provided individual participant data. Evidence of the BAASIS' stability over time supports its reliability. Validity testing of relationships with other variables showed that BAASIS-assessed nonadherence was significantly associated with the selected variables: electronically monitored nonadherence ( P < 0.03), other self- and collaterally-reported nonadherence ( P < 0.001), higher variability in tacrolimus concentrations ( P = 0.02), higher barriers ( P < 0.001), lower self-efficacy ( P < 0.001), lower intention ( P < 0.001), and higher worries ( P = 0.02). Nonadherence also decreased after regimen change interventions ( P = 0.03). Response process evaluation indicated good readability and slightly higher nonadherence with the written version. Structurally, items on taking and timing shared variability. CONCLUSIONS The BAASIS shows good validity and reliability as a self-report instrument to assess medication nonadherence in transplantation.
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Affiliation(s)
- Kris Denhaerynck
- Institute of Nursing Science, Department of Public Health, University of Basel, Switzerland
| | - Fabienne Dobbels
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Barbora Košťálová
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Prague, Czech Republic
| | - Sabina De Geest
- Institute of Nursing Science, Department of Public Health, University of Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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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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Cartwright Y, Tangney C, Ruppar T, Epting SM, Jenkins L, Julion W, Rothschild S, Zimmermann L, Avery E, Olinger T, Suzuki S, Lynch E. Rationale and design of the Heart-to-Heart study: A church-based intervention to reduce blood pressure in African Americans. Contemp Clin Trials 2023; 130:107213. [PMID: 37127255 PMCID: PMC10330430 DOI: 10.1016/j.cct.2023.107213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/03/2023]
Abstract
Heart-to-Heart (H2H) is a church-based behavioral cluster randomized trial to measure the effectiveness of a lifestyle education program for reducing blood pressure (BP) in African American adults with uncontrolled BP. Design and implementation of this study were informed by our ALIVE pilot study conducted with church pastors and leaders using a community-based participatory research methodology. The current study employs a cross-over design in which all participants receive two 6-month programs in different orders: the intervention arm receives the H2H program first, followed by a financial education program, and the comparator arm receives the programs in the reverse order. Approximately 34 churches will be randomized with the aim of including at least 272 participants across churches. The H2H program consists of 24 weekly dietitian-led diet and lifestyle virtual education sessions, 12 Bible studies taught by the church pastor reinforcing positive dietary behaviors from a biblical perspective, daily self-monitoring of BP, and, as needed, one-on-one support from a community health worker to assist with medication adherence. The Money Smart program consists of 14 financial education sessions and 12 Bible studies teaching the biblical basis of good financial management over a 6-month period. The primary outcome measure is systolic BP at 6 months with a follow-up at 12 months. Secondary outcome measures include medication adherence, Dietary Approaches to Stop Hypertension (DASH) diet adherence, self-efficacy for hypertension self-care, social support for eating a healthy diet, hypertension and nutrition knowledge, beliefs about medicines, barriers to medication use, depression, and financial knowledge and behaviors.
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Affiliation(s)
- Yolanda Cartwright
- Department of Family and Preventive Medicine, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 302, Chicago, IL 60612, United States of America.
| | - Christy Tangney
- Department of Family and Preventive Medicine, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 302, Chicago, IL 60612, United States of America
| | - Todd Ruppar
- Department of Adult Health and Gerontological Nursing, Rush University Medical Center, 600 S. Paulina Ave., Suite 1080, Chicago, IL 60612, United States of America
| | - Steve M Epting
- Department of Family and Preventive Medicine, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 302, Chicago, IL 60612, United States of America; Hope Community Church, 5900 W. Iowa Street, Chicago, IL 60651, United States of America
| | - LaDawne Jenkins
- Department of Family and Preventive Medicine, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 302, Chicago, IL 60612, United States of America
| | - Wrenetha Julion
- Department of Women, Children & Family Nursing, Rush University Medical Center, 600 S. Paulina Ave., Suite 1080, Chicago, IL 60612, United States of America
| | - Steve Rothschild
- Department of Family and Preventive Medicine, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 302, Chicago, IL 60612, United States of America
| | - Laura Zimmermann
- Department of Family and Preventive Medicine, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 302, Chicago, IL 60612, United States of America
| | - Elizabeth Avery
- Department of Family and Preventive Medicine, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 302, Chicago, IL 60612, United States of America
| | - Tami Olinger
- Department of Family and Preventive Medicine, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 302, Chicago, IL 60612, United States of America
| | - Sumihiro Suzuki
- Department of Family and Preventive Medicine, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 302, Chicago, IL 60612, United States of America
| | - Elizabeth Lynch
- Department of Family and Preventive Medicine, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 302, Chicago, IL 60612, United States of America
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Kindem IA, Bjerre A, Hammarstrøm C, Naper C, Midtvedt K, Åsberg A. Kidney-transplanted Adolescents-Nonadherence and Graft Outcomes During the Transition Phase: A Nationwide Analysis, 2000-2020. Transplantation 2023; 107:1206-1212. [PMID: 36476728 PMCID: PMC10125107 DOI: 10.1097/tp.0000000000004431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The transition from pediatric to young adult care is a vulnerable period for the renal transplant patient. We aimed to identify medication nonadherence (noninitiation, nonimplementation, and nonpersistence) and graft loss rates among adolescents and young adults and elucidate the influence of the transition phase on transplant outcomes. METHODS A retrospective nationwide cohort analysis of all renal transplantations in Norway from 2000 to 2020 was performed. Data were retrieved from the Norwegian Renal Registry, and adherence data from hospital charts. Patients transplanted aged <50 y, with functioning graft at 6 mo, were included. Recipients transplanted aged <26 y were compared with recipients transplanted aged 26-50 y. Graft loss, acute rejection, and development of de novo donor-specific antibodies were assessed in relation to the transition phase, defined as 14-26 y. RESULTS Data from 1830 kidney recipients were included: 371 (20%) transplanted <26 y (64% male, 68% living donor) versus 1459 transplanted 26-50 y (63% male, 44% living donor). There were 298 graft losses, 78 (21%) in the <26-y group versus 220 (15%) in the 26- to 50-y group. During the transition phase, 36 grafts were lost, 29 (81%) after transfer to the adult service. Medication nonadherence was the reason for 58% (21 of 36) of the losses during the transition phase, versus 12% (27 of 220) in the 26- to 50-y group ( P < 0.001). The 5-y graft survival rate was 89% (95% confidence interval, 85%-92%) and 94% (92%-95%), respectively ( P = 0.01). CONCLUSIONS Nonadherence was verified as the main cause of kidney graft loss in the transition phase.
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Affiliation(s)
- Ingvild A. Kindem
- Department of Pediatrics, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Anna Bjerre
- Department of Pediatrics, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Clara Hammarstrøm
- Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Christian Naper
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- The Norwegian Renal Registry, Oslo University Hospital, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
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10
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Vaisbourd Y, Dahhou M, Zhang X, Sapir-Pichhadze R, Cardinal H, Johnston O, Blydt-Hansen TD, Tibbles LA, Hamiwka L, Urschel S, Birk P, Bissonnette J, Matsuda-Abedini M, BScPhm JH, Schiff J, Phan V, De Geest S, Allen U, Avitzur Y, Mital S, Foster BJ. Differences in medication adherence by sex and organ type among adolescent and young adult solid organ transplant recipients. Pediatr Transplant 2023; 27:e14446. [PMID: 36478059 DOI: 10.1111/petr.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Identification of differences in medication adherence by sex or organ type may help in planning interventions to optimize outcomes. We compared immunosuppressive medication adherence between males and females, and between kidney, liver and heart transplant recipients. METHODS This multicenter study of prevalent kidney, liver and heart transplant recipients 14-25 years assessed adherence 3 times (0, 3, 6 months post-enrollment) with the BAASIS self-report tool. At each visit, participants were classified as adherent if they missed no doses in the prior 4 weeks and non-adherent otherwise. Adherence was also assessed using the coefficient of variation (CV) of tacrolimus trough levels; CV < 30% was classified as adherent. We used multivariable mixed effects logistic regression models adjusted for potential confounders to compare adherence by sex and by organ. RESULTS Across all visits, males (n = 150, median age 20.4 years, IQR 17.2-23.3) had lower odds of self-reported adherence than females (n = 120, median age 19.8 years, IQR 17.1-22.7) (OR 0.41, 95% CI 0.21-0.80) but higher odds of adherence by tacrolimus CV (OR 2.50, 95% CI 1.30-4.82). No significant differences in adherence (by self-report or tacrolimus CV) were noted between the 184 kidney, 58 liver, and 28 heart recipients. CONCLUSION Females show better self-reported adherence than males but greater variability in tacrolimus levels. Social desirability bias, more common in females than males, may contribute to better self-reported adherence among females. Higher tacrolimus variability among females may reflect biologic differences in tacrolimus metabolism between males and females rather than sex differences in adherence. There were no significant differences in adherence by organ type.
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Affiliation(s)
| | - Mourad Dahhou
- Research Institute of The McGill University Health Centre, Quebec, Canada
| | - Xun Zhang
- Research Institute of The McGill University Health Centre, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Research Institute of The McGill University Health Centre, Quebec, Canada.,Department of Medicine, McGill University, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
| | | | - Olwyn Johnston
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lee Anne Tibbles
- Department of Medicine and Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine Hamiwka
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon Urschel
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Patricia Birk
- Section of Pediatric Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Mina Matsuda-Abedini
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Harrison BScPhm
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Ajmera Transplant Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jeffrey Schiff
- Ajmera Transplant Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Sabina De Geest
- Department Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Primary Care and Public Health, Academic Center of Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Upton Allen
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Yaron Avitzur
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Seema Mital
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, Ontario, Canada
| | - Bethany J Foster
- Department of Pediatrics, McGill University, Quebec, Canada.,Research Institute of The McGill University Health Centre, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
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11
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022; 42:e1-e141. [PMID: 37080658 DOI: 10.1016/j.healun.2022.10.015] [Citation(s) in RCA: 125] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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12
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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13
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Cajita MI, Denhaerynck K, Berben L, Dobbels F, Van Cleemput J, Crespo-Leiro M, Van Keer J, Poncelet AJ, Russell C, De Geest S. Is degree of chronic illness management in heart transplant centers associated with better patient survival? Findings from the intercontinental BRIGHT study. Chronic Illn 2022; 18:806-817. [PMID: 34549630 PMCID: PMC9643815 DOI: 10.1177/17423953211039773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore the association between the degree of Chronic illness management and survival rates at 1-, 3-, 5-years post heart transplantation. METHODS Exploratory secondary analysis of a cross-sectional, international study (Building Research Initiative Group study). Latent profile analysis was performed to classify 36 heart transplant centers according to the degree of chronic illness management. RESULTS The analysis resulted in 2 classes with 29 centers classified as "low-degree chronic illness management" and 7 centers as "high-degree chronic illness management". After 1-year posttransplantation, the high-degree chronic illness management class had a significantly greater mean survival rate compared to the low-degree chronic illness management class (88.4% vs 84.2%, p = 0.045) and the difference had a medium effect size (η2 = .06). No difference in survival for the other time points was observed. Patients in high-degree chronic illness management centers had 52% lower odds of moderate to severe drinking (95% confidence interval .30-.78, p = 0.003). No significant associations between degree of chronic illness management and the other recommended health behaviors were observed. CONCLUSIONS The findings from this exploratory study offer preliminary insight into a system-level pathway (chronic illness management) for improving outcomes for heart transplant recipients. The signals observed in our data support further investigation into the effectiveness of chronic illness management-based interventions in heart transplant follow-up care.
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Affiliation(s)
| | - Kris Denhaerynck
- Department Public Health, Institute of Nursing Science, 27209University of Basel, Switzerland
| | - Lut Berben
- Department Public Health, Institute of Nursing Science, 27209University of Basel, Switzerland
| | - Fabienne Dobbels
- Department Public Health, Institute of Nursing Science, 27209University of Basel, Switzerland.,Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, 26657KU Leuven, Belgium
| | - Johan Van Cleemput
- Heart Transplant Program, University Hospital of Leuven, Faculty of Medicine, 60182KU Leuven, Leuven, Belgium
| | - Maria Crespo-Leiro
- 16811Complexo Hospitalario Universitario A Coruña (CHUAC), CIBERCV, INIBIC, Universidade da Coruña (UDC), La Coruña, Spain
| | - Jan Van Keer
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Cynthia Russell
- School of Nursing and Health Studies, 12273University of Missouri-Kansas City, Kansas City, MO, USA
| | - Sabina De Geest
- Department Public Health, Institute of Nursing Science, 27209University of Basel, Switzerland.,Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, 26657KU Leuven, Belgium
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Abshire Saylor M, Denhaerynck K, Mielke J, Davidson PM, Dobbels F, Russell CL, De Geest S. Multi-level correlates of received social support among heart transplant recipients in the international BRIGHT Study: a secondary analysis. Eur J Cardiovasc Nurs 2022; 21:857-867. [PMID: 35670232 DOI: 10.1093/eurjcn/zvac041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 12/29/2022]
Abstract
AIMS Social support is critical in follow-up of patients after heart transplant (HTx) and positively influences well-being and clinical outcomes such as medication adherence. The purpose of this study was to (i) explore received social support variation (emotional and practical) in HTx recipients at country and centre level and (ii) to assess multi-level correlates. METHODS AND RESULTS Secondary data analysis of the multi-level cross-sectional BRIGHT study was conducted in 36 HTx centres in 11 countries. Received social support related to medication adherence was measured with emotional and practical sub-scales. The Conceptual Model of Social Networks and Health guided selection of patient, micro (interpersonal and psychosocial), meso (HTx centre) and macro-level (country health system) factors. Descriptive statistics, intraclass correlations, and sequential multiple ordinal mixed logistic regression analysis were used. A total of 1379 adult HTx recipients were included. Patient level correlates (female sex, living alone, and fewer depressive symptoms) and micro-level correlates (higher level of chronic disease management and trust in the healthcare team) were associated with better emotional social support. Similarly, patient level (living alone, younger age, and male sex), micro-level and meso-level (patient and clinician-rated higher level of chronic disease management) were associated with better practical social support. Social support varied at country and centre levels for emotional and practical dimensions. CONCLUSIONS Social support in HTx recipients varies by country, centre, and was associated with multi-level correlates. Qualitative and longitudinal studies are needed to understand influencing factors of social support for intervention development, improvement of social support, and clinical outcomes.
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Affiliation(s)
- Martha Abshire Saylor
- Johns Hopkins University School of Nursing, 525 N Wolfe St., Baltimore, MD, 21205USA
| | - Kris Denhaerynck
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Juliane Mielke
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Patricia M Davidson
- University of Wollongong, NSW, Australia.,Johns Hopkins University School of Nursing, 525 N Wolfe St., Baltimore, MD, 21205USA
| | - Fabienne Dobbels
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU, Leuven, Belgium
| | - Cynthia L Russell
- School of Nursing Nursing and Health Studies, University of Missouri-Kansas City, Missouri, USA
| | - Sabina De Geest
- Institute of Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,School of Nursing Nursing and Health Studies, University of Missouri-Kansas City, Missouri, USA
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15
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Mielke J, Leppla L, Valenta S, Zullig LL, Zúñiga F, Staudacher S, Teynor A, De Geest S. Unraveling implementation context: the Basel Approach for coNtextual ANAlysis (BANANA) in implementation science and its application in the SMILe project. Implement Sci Commun 2022; 3:102. [PMID: 36183141 PMCID: PMC9526967 DOI: 10.1186/s43058-022-00354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Designing intervention and implementation strategies with careful consideration of context is essential for successful implementation science projects. Although the importance of context has been emphasized and methodology for its analysis is emerging, researchers have little guidance on how to plan, perform, and report contextual analysis. Therefore, our aim was to describe the Basel Approach for coNtextual ANAlysis (BANANA) and to demonstrate its application on an ongoing multi-site, multiphase implementation science project to develop/adapt, implement, and evaluate an integrated care model in allogeneic SteM cell transplantatIon facILitated by eHealth (the SMILe project). METHODS BANANA builds on guidance for assessing context by Stange and Glasgow (Contextual factors: the importance of considering and reporting on context in research on the patient-centered medical home, 2013). Based on a literature review, BANANA was developed in ten discussion sessions with implementation science experts and a medical anthropologist to guide the SMILe project's contextual analysis. BANANA's theoretical basis is the Context and Implementation of Complex Interventions (CICI) framework. Working from an ecological perspective, CICI acknowledges contextual dynamics and distinguishes between context and setting (the implementation's physical location). RESULTS BANANA entails six components: (1) choose a theory, model, or framework (TMF) to guide the contextual analysis; (2) use empirical evidence derived from primary and/or secondary data to identify relevant contextual factors; (3) involve stakeholders throughout contextual analysis; (4) choose a study design to assess context; (5) determine contextual factors' relevance to implementation strategies/outcomes and intervention co-design; and (6) report findings of contextual analysis following appropriate reporting guidelines. Partly run simultaneously, the first three components form a basis both for the identification of relevant contextual factors and for the next components of the BANANA approach. DISCUSSION Understanding of context is indispensable for a successful implementation science project. BANANA provides much-needed methodological guidance for contextual analysis. In subsequent phases, it helps researchers apply the results to intervention development/adaption and choices of contextually tailored implementation strategies. For future implementation science projects, BANANA's principles will guide researchers first to gather relevant information on their target context, then to inform all subsequent phases of their implementation science project to strengthen every part of their work and fulfill their implementation goals.
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Affiliation(s)
- Juliane Mielke
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Lynn Leppla
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
- Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg, Freiburg im Breisgau, Germany
| | - Sabine Valenta
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Leah L. Zullig
- Center for Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care & System, and Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC USA
| | - Franziska Zúñiga
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Sandra Staudacher
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Alexandra Teynor
- University of Applied Sciences Augsburg, Faculty of Computer Science, Augsburg, Germany
| | - Sabina De Geest
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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16
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Mellon L, Doyle F, Hickey A, Ward KD, de Freitas DG, McCormick PA, O'Connell O, Conlon P. Interventions for increasing immunosuppressant medication adherence in solid organ transplant recipients. Cochrane Database Syst Rev 2022; 9:CD012854. [PMID: 36094829 PMCID: PMC9466987 DOI: 10.1002/14651858.cd012854.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Non-adherence to immunosuppressant therapy is a significant concern following a solid organ transplant, given its association with graft failure. Adherence to immunosuppressant therapy is a modifiable patient behaviour, and different approaches to increasing adherence have emerged, including multi-component interventions. There has been limited exploration of the effectiveness of interventions to increase adherence to immunosuppressant therapy. OBJECTIVES This review aimed to look at the benefits and harms of using interventions for increasing adherence to immunosuppressant therapies in solid organ transplant recipients, including adults and children with a heart, lung, kidney, liver and pancreas transplant. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 14 October 2021 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register were identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA All randomised controlled trials (RCTs), quasi-RCTs, and cluster RCTs examining interventions to increase immunosuppressant adherence following a solid organ transplant (heart, lung, kidney, liver, pancreas) were included. There were no restrictions on language or publication type. DATA COLLECTION AND ANALYSIS Two authors independently screened titles and abstracts of identified records, evaluated study quality and assessed the quality of the evidence using the GRADE approach. The risk of bias was assessed using the Cochrane tool. The ABC taxonomy for measuring medication adherence provided the analysis framework, and the primary outcomes were immunosuppressant medication initiation, implementation (taking adherence, dosing adherence, timing adherence, drug holidays) and persistence. Secondary outcomes were surrogate markers of adherence, including self-reported adherence, trough concentration levels of immunosuppressant medication, acute graft rejection, graft loss, death, hospital readmission and health-related quality of life (HRQoL). Meta-analysis was conducted where possible, and narrative synthesis was carried out for the remainder of the results. MAIN RESULTS Forty studies involving 3896 randomised participants (3718 adults and 178 adolescents) were included. Studies were heterogeneous in terms of the type of intervention and outcomes assessed. The majority of studies (80%) were conducted in kidney transplant recipients. Two studies examined paediatric solid organ transplant recipients. The risk of bias was generally high or unclear, leading to lower certainty in the results. Initiation of immunosuppression was not measured by the included studies. There is uncertain evidence of an association between immunosuppressant medication adherence interventions and the proportion of participants classified as adherent to taking immunosuppressant medication (4 studies, 445 participants: RR 1.09, 95% CI 0.95 to 1.20; I² = 78%). There was very marked heterogeneity in treatment effects between the four studies evaluating taking adherence, which may have been due to the different types of interventions used. There was evidence of increasing dosing adherence in the intervention group (8 studies, 713 participants: RR 1.14, 95% CI 1.03 to 1.26, I² = 61%). There was very marked heterogeneity in treatment effects between the eight studies evaluating dosing adherence, which may have been due to the different types of interventions used. It was uncertain if an intervention to increase immunosuppressant adherence had an effect on timing adherence or drug holidays. There was limited evidence that an intervention to increase immunosuppressant adherence had an effect on persistence. There was limited evidence that an intervention to increase immunosuppressant adherence had an effect on secondary outcomes. For self-reported adherence, it is uncertain whether an intervention to increase adherence to immunosuppressant medication increases the proportion of participants classified as medically adherent to immunosuppressant therapy (9 studies, 755 participants: RR 1.21, 95% CI 0.99 to 1.49; I² = 74%; very low certainty evidence). Similarly, it is uncertain whether an intervention to increase adherence to immunosuppressant medication increases the mean adherence score on self-reported adherence measures (5 studies, 471 participants: SMD 0.65, 95% CI -0.31 to 1.60; I² = 96%; very low certainty evidence). For immunosuppressant trough concentration levels, it is uncertain whether an intervention to increase adherence to immunosuppressant medication increases the proportion of participants who reach target immunosuppressant trough concentration levels (4 studies, 348 participants: RR 0.98, 95% CI 0.68 to 1.40; I² = 40%; very low certainty evidence). It is uncertain whether an intervention to increase adherence to immunosuppressant medication may reduce hospitalisations (5 studies, 460 participants: RR 0.67, 95% CI 0.44 to 1.02; I² = 64%; low certainty evidence). There were limited, low certainty effects on patient-reported health outcomes such as HRQoL. There was no clear evidence to determine the effect of interventions on secondary outcomes, including acute graft rejection, graft loss and death. No harms from intervention participation were reported. AUTHORS' CONCLUSIONS Interventions to increase taking and dosing adherence to immunosuppressant therapy may be effective; however, our findings suggest that current evidence in support of interventions to increase adherence to immunosuppressant therapy is overall of low methodological quality, attributable to small sample sizes, and heterogeneity identified for the types of interventions. Twenty-four studies are currently ongoing or awaiting assessment (3248 proposed participants); therefore, it is possible that findings may change with the inclusion of these large ongoing studies in future updates.
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Affiliation(s)
- Lisa Mellon
- Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anne Hickey
- Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kenneth D Ward
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Declan G de Freitas
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital, Dublin, Ireland
| | - P Aiden McCormick
- Irish Liver Transplant Unit, St Vincent's University Hospital, Dublin, Ireland
| | - Oisin O'Connell
- Irish National Lung and Heart Transplant Program, Mater Misericordiae University, Dublin, Ireland
| | - Peter Conlon
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital, Dublin, Ireland
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Health Facts Medication Adherence in Transplantation (H-MAT) Study: A Secondary Analysis of Determinants and Outcomes of Medication Nonadherence in Adult Kidney Transplant Recipients. Int J Nephrol 2022; 2022:9653847. [PMID: 35721370 PMCID: PMC9205738 DOI: 10.1155/2022/9653847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/21/2022] [Indexed: 01/08/2023] Open
Abstract
Aims To explore the relationship between determinants and posttransplant medication nonadherence (MNA) in adult kidney transplant recipients, and to examine the relationship between posttransplant MNA and clinical outcomes. Methods Using the World Health Organization's model, this retrospective, multicenter, correlational study examined the relationship between determinants, posttransplant MNA, and clinical outcomes in 16,671 adult kidney transplant recipients from the Cerner Health Facts national data warehouse. Results With 12% MNA, those who were nonadherent were more likely to have the social/economic factors of being younger, single, Caucasian versus Hispanic race, have the condition-related factor of mental health/substance use disorder, and have the healthcare system-related factor of government/health maintenance organization/managed care insurance (p′s < 0.05). Bivariate correlations indicated both age (OR = 1.006, p=0.01) and mental health or substance use disorder diagnosis (OR = 1.26, p=0.04) were significant predictors of MNA. Patients were 0.6% more likely to be medication adherent for each year they increased in age and 26% more likely to be MNA if they were diagnosed with a mental health/substance use disorder. Nonadherent patients were less likely to be readmitted, but more likely to have complications after transplant and medication side effects (p′s < 0.01). Conclusions Using one of the largest samples of adult kidney transplant patients, our findings support the WHO model and move the body of medication adherence intervention research forward by clarifying the importance of focusing interventions not only on the patient but on multilevel determinants. Consistent with previous studies, MNA negatively impacts transplant outcomes.
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Beckmann S, Mauthner O, Schick L, Rochat J, Lovis C, Boehler A, Binet I, Huynh-Do U, De Geest S. A National Survey Comparing Patients' and Transplant Professionals' Research Priorities in the Swiss Transplant Cohort Study. Transpl Int 2022; 35:10255. [PMID: 35664427 PMCID: PMC9156624 DOI: 10.3389/ti.2022.10255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/08/2022] [Indexed: 11/13/2022]
Abstract
We aimed to identify, assess, compare and map research priorities of patients and professionals in the Swiss Transplant Cohort Study. The project followed 3 steps. 1) Focus group interviews identified patients' (n = 22) research priorities. 2) A nationwide survey assessed and compared the priorities in 292 patients and 175 professionals. 3) Priorities were mapped to the 4 levels of Bronfenbrenner's ecological framework. The 13 research priorities (financial pressure, medication taking, continuity of care, emotional well-being, return to work, trustful relationships, person-centredness, organization of care, exercise and physical fitness, graft functioning, pregnancy, peer contact and public knowledge of transplantation), addressed all framework levels: patient (n = 7), micro (n = 3), meso (n = 2), and macro (n = 1). Comparing each group's top 10 priorities revealed that continuity of care received highest importance rating from both (92.2% patients, 92.5% professionals), with 3 more agreements between the groups. Otherwise, perspectives were more diverse than congruent: Patients emphasized patient level priorities (emotional well-being, graft functioning, return to work), professionals those on the meso level (continuity of care, organization of care). Patients' research priorities highlighted a need to expand research to the micro, meso and macro level. Discrepancies should be recognized to avoid understudying topics that are more important to professionals than to patients.
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Affiliation(s)
- Sonja Beckmann
- Department Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland,Center Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Mauthner
- Department Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland,University Department of Geriatric Medicine Felix Platter, Basel, Switzerland
| | | | - Jessica Rochat
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Faculty of Medicine, University of Geneva, Geneva, Switzerland,Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | | | - Isabelle Binet
- Service of Nephrology and Transplantation Medicine, Cantonal Hospital, St. Gallen, Switzerland
| | - Uyen Huynh-Do
- Department of Nephrology and Hypertension, Inselspital, University of Bern, Bern, Switzerland
| | - Sabina De Geest
- Department Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland,Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium,*Correspondence: Sabina De Geest,
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Delameillieure A, Dobbels F, Fieuws S, Leceuvre K, Vanderauwera S, Wuyts WA. Behavioural and psychological patterns of patients with idiopathic pulmonary fibrosis: a prospective study. Respir Res 2022; 23:124. [PMID: 35568881 PMCID: PMC9107011 DOI: 10.1186/s12931-022-02041-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive lung condition. Currently, care models predominantly focus on acute medical and pharmacological needs. As a step towards holistic care, the aim of this prospective study was to investigate the psychological and behavioural needs of IPF patients treated with pirfenidone from diagnosis until two years of follow-up. Methods The following variables were selected from the literature on patients’ needs and the COM-B model, a theoretical model explaining behaviour: medication adherence, barriers to adherence, importance and intentions of medication adherence, anxiety, depression, health literacy, knowledge, reported side effects, adherence to sun protection recommendations, alcohol use, physical activity, quality of life and health status. Linear and generalised linear models for longitudinal data were used to evaluate the evolution since treatment initiation. Results We included 66 outpatients: 72.7% men, mean age of 70.3 years (range 50–87), predicted mean forced vital capacity of 85.8% (SD 17.4) and predicted mean diffusing capacity for monoxide of 56.9% (SD 15.7). The participants placed considerable importance on following the treatment recommendations. We noticed difficulties regarding health literacy, alcohol use, pirfenidone adherence (decline over time) and adherence to sun protection recommendations (early in follow-up care). There were low levels of physical activity (no effect of time), high body mass indices (decline over time) and moderate levels of depression and anxiety. Conclusion When providing care to IPF patients, behavioural issues, health literacy and psychological well-being should be taken into consideration. There is a need to further explore interventions and care models to tackle these difficulties. Trial registration This study was registered in the ClinicalTrials.gov database (identifier NCT03567785) on May 9th, 2018 Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02041-6.
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Affiliation(s)
- Anouk Delameillieure
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven, Kapucijnenvoer 35 blok D-box 7001, 3000, Leuven, Belgium. .,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Steffen Fieuws
- L-BioStat, Louvain Biostatistics and Statistical Bioinformatics Centre, KU Leuven, Leuven, Belgium
| | - Katleen Leceuvre
- Department of Respiratory Diseases, Unit for Interstitial Lung Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Sara Vanderauwera
- Department of Respiratory Diseases, Unit for Interstitial Lung Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Wim A Wuyts
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven, Kapucijnenvoer 35 blok D-box 7001, 3000, Leuven, Belgium.,Department of Respiratory Diseases, Unit for Interstitial Lung Diseases, University Hospitals Leuven, Leuven, Belgium
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20
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Rose Epstein F, Trammell J, Liu CM, Denhaerynck K, Dobbels F, Russell C, De Geest S. A Secondary Analysis from The International BRIGHT Study For Gender Differences In Adherence To Nonpharmacological Health-Related Behaviors After Heart Transplantation. Prog Transplant 2022; 32:138-147. [PMID: 35331039 DOI: 10.1177/15269248221087435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Flavio Rose Epstein
- 6152Kaiser Permanente, Advanced Heart Failure Therapies, Santa Clara, California, USA
| | - Jacqueline Trammell
- 6152Kaiser Permanente, Advanced Heart Failure Therapies, Santa Clara, California, USA
| | - Chi-Mei Liu
- 6152Kaiser Permanente, Advanced Heart Failure Therapies, Santa Clara, California, USA
| | - Kris Denhaerynck
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, 27209University of Basel, Basel, Switzerland
| | - Fabienne Dobbels
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, 27209University of Basel, Basel, Switzerland.,Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, 26657KU Leuven, Leuven, Belgium
| | - Cynthia Russell
- School of Nursing, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Sabina De Geest
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, 27209University of Basel, Basel, Switzerland.,Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, 26657KU Leuven, Leuven, Belgium
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21
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Dziarmaga R, Ke D, Sapir-Pichhadze R, Cardinal H, Phan V, Piccirillo CA, Mazer B, Foster BJ. Age- and sex-mediated differences in T lymphocyte populations of kidney transplant recipients. Pediatr Transplant 2022; 26:e14150. [PMID: 34569133 DOI: 10.1111/petr.14150] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Graft failure rates increase through childhood and adolescence, decline in adulthood, and are higher in female than male kidney transplant recipients (KTR) until middle age. We aimed to describe age- and sex-related differences in T-cell subsets among KTR to determine which differences may help to explain the differences in kidney graft failure rates. METHODS Effector T (Teff)-cell and regulatory T (Treg)-cell phenotypes in PBMCs from healthy controls and KTR, who were at least 1 year post-transplant with stable graft function under immunosuppression, were analyzed by flow cytometry. The effects of age, sex, and status (KTR or control) were analyzed using linear regressions. RESULTS We enrolled 20 male and 21 female KTR and 20 male and 20 female controls between 3 and 29 years of age. CD3+ T-cell frequencies were not associated with age or sex but were higher in KTR than controls. There were no differences in CD4+ and CD8+ frequencies. Th1 (IFNγ+ IL-4- IL-17A-) and Th17 (IL-17A+) frequencies within the CD4+ T-cell population were higher at older ages. The frequencies of FOXP3 + Helios + Treg cells in CD4+ CD25+ CD127- T cells were lower in females than males and in KTR than controls. CONCLUSIONS Increasing frequencies of Th1 and Th17 cells with increasing age mirrors the increasing graft failure rates from childhood to young adulthood. Importantly, sex differences in frequencies of circulating Treg cells may suggest a role in the sex differences in graft failure rates.
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Affiliation(s)
- Robert Dziarmaga
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Danbing Ke
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Ruth Sapir-Pichhadze
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Nephrology and Multi-Organ Transplant Program, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Héloïse Cardinal
- Département de Médecine, Université de Montréal, Montreal, Quebec, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Véronique Phan
- Département de Pédiatrie, Université de Montréal, Montreal, Quebec, Canada.,Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Ciriaco A Piccirillo
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Bruce Mazer
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada.,Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Bethany J Foster
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Pediatrics, McGill University, Montreal, Quebec, Canada
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22
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Fernandez HE, Foster BJ. Long-Term Care of the Pediatric Kidney Transplant Recipient. Clin J Am Soc Nephrol 2022; 17:296-304. [PMID: 33980614 PMCID: PMC8823932 DOI: 10.2215/cjn.16891020] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pediatric kidney transplant recipients are distinguished from adult recipients by the need for many decades of graft function, the potential effect of CKD on neurodevelopment, and the changing immune environment of a developing human. The entire life of an individual who receives a transplant as a child is colored by their status as a transplant recipient. Not only must these young recipients negotiate all of the usual challenges of emerging adulthood (transition from school to work, romantic relationships, achieving independence from parents), but they must learn to manage a life-threatening medical condition independently. Regardless of the age at transplantation, graft failure rates are higher during adolescence and young adulthood than at any other age. All pediatric transplant recipients must pass through this high-risk period. Factors contributing to the high graft failure rates in this period include poor adherence to treatment, potentially exacerbated by the transfer of care from pediatric- to adult-oriented care providers, and perhaps an increased potency of the immune response. We describe the characteristics of pediatric kidney transplant recipients, particularly those factors that may influence their care throughout their lives. We also discuss the risks associated with the transition from pediatric- to adult-oriented care and provide some suggestions to optimize the transition to adult-oriented transplant care and long-term outcomes.
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Affiliation(s)
- Hilda E. Fernandez
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Bethany J. Foster
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada,Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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23
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Valenta S, Ribaut J, Leppla L, Mielke J, Teynor A, Koehly K, Gerull S, Grossmann F, Witzig-Brändli V, De Geest S. Context-specific adaptation of an eHealth-facilitated, integrated care model and tailoring its implementation strategies-A mixed-methods study as a part of the SMILe implementation science project. FRONTIERS IN HEALTH SERVICES 2022; 2:977564. [PMID: 36925799 PMCID: PMC10012712 DOI: 10.3389/frhs.2022.977564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/30/2022] [Indexed: 02/19/2023]
Abstract
Background Contextually adapting complex interventions and tailoring their implementation strategies is key to a successful and sustainable implementation. While reporting guidelines for adaptations and tailoring exist, less is known about how to conduct context-specific adaptations of complex health care interventions. Aims To describe in methodological terms how the merging of contextual analysis results (step 1) with stakeholder involvement, and considering overarching regulations (step 2) informed our adaptation of an Integrated Care Model (ICM) for SteM cell transplantatIon faciLitated by eHealth (SMILe) and the tailoring of its implementation strategies (step 3). Methods Step 1: We used a mixed-methods design at University Hospital Basel, guided by the Basel Approach for coNtextual ANAlysis (BANANA). Step 2: Adaptations of the SMILe-ICM and tailoring of implementation strategies were discussed with an interdisciplinary team (n = 28) by considering setting specific and higher-level regulatory scenarios. Usability tests were conducted with patients (n = 5) and clinicians (n = 4). Step 3: Adaptations were conducted by merging our results from steps 1 and 2 using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME). We tailored implementation strategies according to the Expert Recommendations for Implementing Change (ERIC) compilation. Results Step 1: Current clinical practice was mostly acute-care-driven. Patients and clinicians valued eHealth-facilitated ICMs to support trustful patient-clinician relationships and the fitting of eHealth components to context-specific needs. Step 2: Based on information from project group meetings, adaptations were necessary on the organizational level (e.g., delivery of self-management information). Regulations informed the tailoring of SMILe-ICM`s visit timepoints and content; data protection management was adapted following Swiss regulations; and steering group meetings supported infrastructure access. The usability tests informed further adaptation of technology components. Step 3: Following FRAME and ERIC, SMILe-ICM and its implementation strategies were contextually adapted and tailored to setting-specific needs. Discussion This study provides a context-driven methodological approach on how to conduct intervention adaptation including the tailoring of its implementation strategies. The revealed meso-, and macro-level differences of the contextual analysis suggest a more targeted approach to enable an in-depth adaptation process. A theory-guided adaptation phase is an important first step and should be sufficiently incorporated and budgeted in implementation science projects.
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Affiliation(s)
- Sabine Valenta
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Janette Ribaut
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Lynn Leppla
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg, Freiburg im Breisgau, Germany
| | - Juliane Mielke
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland
| | - Alexandra Teynor
- Faculty of Computer Science, University of Applied Sciences Augsburg, Augsburg, Germany
| | - Katharina Koehly
- Department of Acute Medicine, Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Sabine Gerull
- Department of Hematology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Florian Grossmann
- Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
| | - Verena Witzig-Brändli
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Clinic for Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Sabina De Geest
- Nursing Science, Department of Public Health, University of Basel, Basel, Switzerland.,Department of Primary Care and Public Health, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
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24
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Shi Y, Dan Z, Tao Z, Miao Q, Chang T, Zhang X, Jiang X, Li X. The translation and validation of the Organ Transplant Symptom and Well-Being Instrument in China. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000718. [PMID: 36962583 PMCID: PMC10021454 DOI: 10.1371/journal.pgph.0000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 07/26/2022] [Indexed: 11/18/2022]
Abstract
To translate the Organ Transplant Symptom and Well-Being instrument (OTSWI) into Chinese and test the reliability and validity of the Chinese version. A total of 259 patients with organ transplants were recruited from The First Affiliated Hospital of China Medical University in Shenyang, from November 2020 to January 2021. Construct validity was evaluated using exploratory factor analysis (EFA) and reliability were assessed using test-retest reliability and internal consistency. The Cronbach's α of the Chinese version of the Organ Transplant Symptom and Well-being instrument was 0.93. EFA demonstrated that 80.785% of the total variance was explained by a seven-factor solution. The criterion validity of the SF-36 was -0.460 (p < .01), while the test-retest reliability was 0.710. The Chinese version of the OTSWI questionnaire is a valid and reliable instrument for assessing the quality of life of organ transplant patients for symptoms and well-being in China.
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Affiliation(s)
- Ying Shi
- Department of Intensive Care Unit, Chongqing University Cancer Hospital Hospital, Chongqing, China
| | - Zhang Dan
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Zijun Tao
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Qi Miao
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Tiantian Chang
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Xu Zhang
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Xiaoyu Jiang
- Department of Transplantation and Hepatobiliary, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, P. R. China
| | - Xiaofei Li
- Department of Intensive Care Unit, Chongqing University Cancer Hospital Hospital, Chongqing, China
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25
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Dabirzadeh A, Dahhou M, Zhang X, Sapir-Pichhadze R, Cardinal H, White M, Johnston O, Blydt-Hansen TD, Tibbles LA, Hamiwka L, Urschel S, Birk P, Bissonnette J, Matsuda-Abedini M, Harrison J, Schiff J, Phan V, De Geest S, Allen U, Mital S, Foster BJ. Care processes and structures associated with higher medication adherence in adolescent and young adult transplant recipients. Pediatr Transplant 2021; 25:e14106. [PMID: 34339090 DOI: 10.1111/petr.14106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to identify care processes and structures that were independently associated with higher medication adherence among young transplant recipients. METHODS We conducted a prospective, observational cohort study of 270 prevalent kidney, liver, and heart transplant recipients 14-25 years old. Patients were ≥3 months post-transplant, ≥2 months post-discharge, and followed in one of 14 pediatric or 14 adult transplant programs in Canada. Patients were enrolled between June 2015 and March 2018 and followed for 6 months. Adherence was assessed at baseline, 3, and 6 months using the BAASIS© self-report tool. Patients were classified as adherent if no doses were missed in the prior 4 weeks. Transplant program directors and nurses completed questionnaires regarding care organization and processes. RESULTS Of the 270 participants, 99 were followed in pediatric programs and 171 in adult programs. Median age was 20.3 years, and median time since transplant was 5 years. At baseline, 71.5% were adherent. Multivariable mixed effects logistic regression models with program as a random effect identified two program-level factors as independently associated with better adherence: minimum number of prescribed blood draws per year for those >3 years post-transplant (per 1 additional) (OR 1.12 [95% CI 1.00, 1.26]; p = .047), and average time nurses spend with patients in clinic (per 5 additional minutes) (OR 1.15 [1.03, 1.29]; p = .017). CONCLUSION Program-level factors including protocols with a greater frequency of routine blood testing and more nurse time with patients were associated with better medication adherence. This suggests that interventions at the program level may support better adherence.
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Affiliation(s)
| | - Mourad Dahhou
- Research Institute of The McGill University Health Centre, Montreal, QC, Canada
| | - Xun Zhang
- Research Institute of The McGill University Health Centre, Montreal, QC, Canada
| | - Ruth Sapir-Pichhadze
- Research Institute of The McGill University Health Centre, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Heloise Cardinal
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Michel White
- Institut de Cardiologie, Université de Montréal, Montreal, QC, Canada
| | - Olwyn Johnston
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Lee Anne Tibbles
- Department of Medicine and Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lorraine Hamiwka
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Simon Urschel
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Patricia Birk
- Section of Pediatric Nephrology, University of Manitoba, Winnipeg, MB, Canada
| | | | - Mina Matsuda-Abedini
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, ON, Canada
| | - Jennifer Harrison
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Multi-Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - Jeffrey Schiff
- Multi-Organ Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - Veronique Phan
- CHU Ste-Justine, Université de Montréal, Montréal, QC, Canada
| | - Sabina De Geest
- Department Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland.,Academic Center of Nursing and Midwifery, Department of Primary Care and Public Health, KU Leuven, Leuven, Belgium
| | - Upton Allen
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, ON, Canada
| | - Seema Mital
- Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, ON, Canada
| | - Bethany J Foster
- Research Institute of The McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Pediatrics, McGill University, Montreal, QC, Canada
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26
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Zelikovsky N, McKelvey E. Looking beyond patient-level variables: Exploration of care processes and structures associated with medication adherence in transplant recipients. Pediatr Transplant 2021; 25:e14099. [PMID: 34309991 DOI: 10.1111/petr.14099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Nataliya Zelikovsky
- Psychology Department, La Salle University, Philadelphia, PA, USA.,Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elise McKelvey
- Psychology Department, La Salle University, Philadelphia, PA, USA
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27
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Devresse A, Gohy S, Robert A, Kanaan N. How to manage cigarette smoking in kidney transplant candidates and recipients? Clin Kidney J 2021; 14:2295-2303. [PMID: 34754426 PMCID: PMC8572985 DOI: 10.1093/ckj/sfab072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/19/2021] [Indexed: 01/15/2023] Open
Abstract
Tobacco smoking is a frequent problem affecting many kidney transplant (KT) candidates and recipients. The negative impact of active smoking on KT outcomes has been demonstrated. Consequently, most guidelines strongly recommend quitting smoking before considering kidney transplantation. However, nicotine addiction is a complex multifactorial disease and only 3-5% of the patients who try to quit by themselves achieve prolonged abstinence. Smoking cessation programmes (SCPs) have proven their efficacy in the general population to increase the rate of quitting and should therefore be proposed to all smoking KT candidates and recipients. Nevertheless, SCPs have not been evaluated in the KT field and not all KT centres have easy access to these programmes. In this work, we aim to review the current knowledge on the subject and provide an overview of the available interventions to help smoking patients quit. We detail non-pharmaceutical and pharmaceutical approaches and discuss their use in KT candidates and recipients.
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Affiliation(s)
- Arnaud Devresse
- Nephrology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Sophie Gohy
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Pneumology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Cystic Fibrosis Reference Center, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Pole of Pneumology, ENT and Dermatology, Université Catholique de Louvain, Brussels, Belgium
| | - Arnaud Robert
- Nephrology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Nada Kanaan
- Nephrology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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28
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Schmithausen A, Tengler A, Birnbaum J, Haas NA, Rosenthal LL, Orban M, Hagl C, Dalla Pozza R, Jakob A, Fischer M, Ulrich SM. Quality of life and patient satisfaction with outpatient care after heart transplantation in adult and pediatric patients - room for improvement? Transpl Int 2021; 34:2578-2588. [PMID: 34709681 DOI: 10.1111/tri.14147] [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: 07/24/2021] [Revised: 09/16/2021] [Accepted: 10/19/2021] [Indexed: 11/28/2022]
Abstract
Reduced adherence after heart transplantation increases the risk for acute rejection. Therefore, the aim of this study was to evaluate the patient's satisfaction with outpatient care and quality of life (QOL) after pediatric and adult heart transplantation. Observational study after pediatric (n = 22) and adult (n = 65) heart transplantation and the parents of the pediatric patients (n = 22) to evaluate the patients' satisfaction with outpatient care and QOL. Established standardized questionnaires were used for patient satisfaction (ZAP survey) and QOL (SF36); the latter was compared with the cohort of the BGS98 survey (BGS98 cohort). ZAP score: excellent results with almost all values >80. QOL: pediatric cohort showed significantly higher values in physical functioning (P = 0.041) and role physical (P = 0.003) but significantly lower values in the sub-scale general health (P = 0.02) compared to adult cohort. In comparison with BGS98 cohort, children showed almost similar results, whereas adult cohort showed worse values in physical and emotional functioning, but higher values regarding general health. The QOL of patients after pediatric heart transplantation is comparable to a standardized reference population in Germany, whereas adult patients show reduced physical and emotional functioning, but better values regarding general health. The patients' satisfaction with the outpatient care is very high.
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Affiliation(s)
- Alexander Schmithausen
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Anja Tengler
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Julia Birnbaum
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Laura L Rosenthal
- Department of Heart Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Madeleine Orban
- Department of Cardiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Hagl
- Department of Heart Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Robert Dalla Pozza
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andre Jakob
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Marcus Fischer
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sarah M Ulrich
- Department of Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
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29
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Schönfeld S, Denhaerynck K, Berben L, Dobbels F, Russell CL, Crespo-Leiro MG, De Geest S. Prevalence and Correlates of Cost-Related Medication Nonadherence to Immunosuppressive Drugs After Heart Transplantation: The International Multicenter Cross-sectional Bright Study. J Cardiovasc Nurs 2021; 35:519-529. [PMID: 32433348 PMCID: PMC7553198 DOI: 10.1097/jcn.0000000000000683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cost-related medication nonadherence (CRMNA) refers to not taking medications as prescribed because of difficulties paying for them. OBJECTIVES The aims of this study were (1) to assess the prevalence of CRMNA to immunosuppressants in heart transplant recipients internationally and (2) to determine multilevel correlates (patient, center, and healthcare system levels) of CRMNA. METHODS Using data from the cross-sectional international BRIGHT study, applying multistaged sampling, CRMNA was assessed via 3 self-report items in 1365 patients from 36 heart transplant centers in 11 countries. Cost-related medication nonadherence was defined as any positive answer on any of the 3 items. Healthcare system-level (ie, insurance coverage, out-of-pocket expenditures) and patient-level (ie, intention, perceived financial burden, cost as a barrier, a health belief regarding medication benefits, cost-related self-efficacy, and demographic factors) CRMNA correlates were assessed. Correlates were examined using mixed logistic regression analysis. RESULTS Across all study countries, CRMNA had an average prevalence of 2.6% (range, 0% [Switzerland/Brazil] to 9.8% [Australia]) and was positively related to being single (odds ratio, 2.29; 95% confidence interval, 1.17-4.47), perceived financial burden (odds ratio, 2.15; 95% confidence interval, 1.55-2.99), and cost as a barrier (odds ratio, 2.60; 95% confidence interval, 1.66-4.07). Four protective factors were identified: white ethnicity (odds ratio, 0.37; 95% confidence interval, 0.19-0.74), intention to adhere (odds ratio, 0.44; 95% confidence interval, 0.31-0.63), self-efficacy (odds ratio, 0.54; 95% confidence interval, 0.43-0.67), and belief about medication benefit (odds ratio, 0.70; 95% confidence interval, 0.57-0.87). Regarding variability, 81.3% was explained at the patient level; 13.8%, at the center level; and 4.8%, at the country level. CONCLUSION In heart transplant recipients, the CRMNA prevalence varies across countries but is lower than in other chronically ill populations. Identified patient-level correlates are novel (ie, intention to adhere, cost-related barriers, and cost-related self-efficacy) and indicate patient-perceived medication cost burden.
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Affiliation(s)
- Sandra Schönfeld
- Sandra Schönfeld, MSN Clinical Nurses Specialist, Institute of Nursing Science, Department Public Health, University of Basel; and University Hospital Basel, Switzerland. Kris Denhaerynck, PhD, RN Postdoctoral Fellow, Institute of Nursing Science, Department Public Health, University of Basel, Switzerland. Lut Berben, PhD, RN Clinical Nurse Specialist, University Hospital Basel, Switzerland. Fabienne Dobbels, PhD, MSc Associate Professor, Academic Center for Nursing and Midwifery, Department Primary Care and Public Health, Faculty of Medicine, KU Leuven, Belgium. Cynthia L. Russell, PhD, RN Professor, School of Nursing, University of Missouri-Kansas City, Missouri. Marisa G. Crespo-Leiro, MD Head Heart Transplant Program, Complexo Hospitalario Universitario A Coruña (CHUAC), CIBERCV, INIBIC, Universidade da Coruña (UDC), La Coruña, Spain. Sabina De Geest, PhD, RN, FAAN, FRCN Professor of Nursing, Director of the Institute of Nursing Science and Chair Department of Public Health, University of Basel, Switzerland
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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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Adherence to Immunosuppression Medications among Heart Transplant Recipients: Challenges, Opportunities, and Potential Role of Digital Approaches in the COVID-19 Era. J Cardiovasc Dev Dis 2021; 8:jcdd8060068. [PMID: 34200823 PMCID: PMC8230436 DOI: 10.3390/jcdd8060068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 12/16/2022] Open
Abstract
Society and medical practice have been restructured dramatically to avoid further spread of the COVID-19 virus; telehealth/telemedicine, mask wearing, and nationwide social distancing practices have become widespread. However, we still face unprecedented challenges in fields where patients require frequent and active follow-up visits for monitoring, including that of solid-organ transplant, and in particular, heart transplant. Adherence to immunosuppression remains a unique challenge in heart transplantation, especially during the COVID-19 pandemic. Failure to adhere to immunosuppression can have disastrous consequences, including graft rejection and death. In this article, we discuss challenges related to adherence to immunosuppression medications among heart transplant recipients, as well as opportunities to leverage digital approaches and interventions to monitor and optimize adherence behavior and health outcomes in this population.
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Marsicano-Souza EO, Colugnati F, Geest SD, Sanders-Pinheiro H. Nonadherence to immunosuppressives and treatment in kidney transplant: ADHERE BRAZIL Study. Rev Saude Publica 2021; 55:33. [PMID: 34076208 PMCID: PMC8139843 DOI: 10.11606/s1518-8787.2021055002894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/25/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and variability of nonadherence to immunosuppressives and nonpharmacological treatment across kidney transplantation centers and two health access-disparate regions in Brazil. METHODS In a cross-sectional design, a random multistage sample of 1,105 patients was included, based on center transplantation activity (low/moderate/high) and region (R1: North/Northeast/Mid-West; and R2: South/Southeast). Nonadherence to immunosuppressives (implementation phase) was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS)©. Self-report questionnaires assessed nonadherence to physical activity, smoking cessation, alcohol intake, and appointment keeping. We compared regions using the adjusted-χ2 or t-test. RESULTS Most patients were men (58.5%), white (51.4%), and had a mean age of 47.5 (SD = 12.6) years. Regarding kidney transplantation centers, 75.9% were from R2 and 38.2% had low activity. The patients in R2 were older, white-majority, had more frequently steady partners, and received peritoneal dialysis. Nonadherence to immunosuppressives ranged from 11-65.2%; 44.5-90% to physical activity; 0-23.7% to appointment keeping; and 0-14% to smoking cessation. The total prevalence of nonadherence and by region (R1 versus R2) were: for immunosuppressives, 39.7% (44.9% versus 38.1%, p = 0.18); for smoking, 3.9% (1% versus 5%, p < 0.001); for physical activity, 69.1% (71% versus 69%, p = 0.48); for appointment keeping, 13% (12.7% versus 12%, p = 0.77); and for alcohol consumption, 0%. CONCLUSION Despite differences among centers and high variability, only the nonadherence to smoking cessation was higher in the region with greater access to kidney transplantation. We suppose that differences in healthcare access may have been overcome by other positive aspects of the post kidney transplantation treatment.
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Affiliation(s)
- Elisa Oliveira Marsicano-Souza
- Universidade Federal de Juiz de ForaHospital UniversitárioUnidade de Transplante RenalJuiz de ForaMGBrasilUniversidade Federal de Juiz de Fora. Hospital Universitário. Unidade de Transplante Renal. Juiz de Fora, MG, Brasil
- Núcleo Interdisciplinar de Estudos e Pesquisas em NefrologiaJuiz de ForaMGBrasilNúcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN). Juiz de Fora, MG, Brasil
| | - Fernando Colugnati
- Universidade Federal de Juiz de ForaHospital UniversitárioUnidade de Transplante RenalJuiz de ForaMGBrasilUniversidade Federal de Juiz de Fora. Hospital Universitário. Unidade de Transplante Renal. Juiz de Fora, MG, Brasil
- Núcleo Interdisciplinar de Estudos e Pesquisas em NefrologiaJuiz de ForaMGBrasilNúcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN). Juiz de Fora, MG, Brasil
| | - Sabina De Geest
- University of BaselInstitute of Nursing ScienceDepartment of Public HealthBaselSwitzerlandUniversity of Basel. Institute of Nursing Science. Department of Public Health. Basel, Switzerland
- KU LeuvenAcademic Centre for Nursing and MidwiferyDepartment of Public Health and Primary CareLeuvenBelgiumKU Leuven. Academic Centre for Nursing and Midwifery. Department of Public Health and Primary Care. Leuven, Belgium
| | - Helady Sanders-Pinheiro
- Universidade Federal de Juiz de ForaHospital UniversitárioUnidade de Transplante RenalJuiz de ForaMGBrasilUniversidade Federal de Juiz de Fora. Hospital Universitário. Unidade de Transplante Renal. Juiz de Fora, MG, Brasil
- Núcleo Interdisciplinar de Estudos e Pesquisas em NefrologiaJuiz de ForaMGBrasilNúcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN). Juiz de Fora, MG, Brasil
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Gomis-Pastor M, Mirabet Perez S, Roig Minguell E, Brossa Loidi V, Lopez Lopez L, Ros Abarca S, Galvez Tugas E, Mas-Malagarriga N, Mangues Bafalluy MA. Mobile Health to Improve Adherence and Patient Experience in Heart Transplantation Recipients: The mHeart Trial. Healthcare (Basel) 2021; 9:healthcare9040463. [PMID: 33919899 PMCID: PMC8070926 DOI: 10.3390/healthcare9040463] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
Non-adherence after heart transplantation (HTx) is a significant problem. The main objective of this study was to evaluate if a mHealth strategy is more effective than standard care in improving adherence and patients’ experience in heart transplant recipients. Methods: This was a single-center, randomized controlled trial (RCT) in adult recipients >1.5 years post-HTx. Participants were randomized to standard care (control group) or to the mHeart Strategy (intervention group). For patients randomized to the mHeart strategy, multifaceted theory-based interventions were provided during the study period to optimize therapy management using the mHeart mobile application. Patient experience regarding their medication regimens were evaluated in a face-to-face interview. Medication adherence was assessed by performing self-reported questionnaires. A composite adherence score that included the SMAQ questionnaire, the coefficient of variation of drug levels and missing visits was also reported. Results: A total of 134 HTx recipients were randomized (intervention N = 71; control N = 63). Mean follow-up was 1.6 (SD 0.6) years. Improvement in adherence from baseline was significantly higher in the intervention group versus the control group according to the SMAQ questionnaire (85% vs. 46%, OR = 6.7 (2.9; 15.8), p-value < 0.001) and the composite score (51% vs. 23%, OR = 0.3 (0.1; 0.6), p-value = 0.001). Patients’ experiences with their drug therapy including knowledge of their medication timing intakes (p-value = 0.019) and the drug indications or uses that they remembered (p-value = 0.003) significantly improved in the intervention versus the control group. Conclusions: In our study, the mHealth-based strategy significantly improved adherence and patient beliefs regarding their medication regimens among the HTx population. The mHeart mobile application was used as a feasible tool for providing long-term, tailor-made interventions to HTx recipients to improve the goals assessed.
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Affiliation(s)
- Mar Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, 08025 Barcelona, Catalonia, Spain
- Correspondence: ; Tel.: +34-667411996
| | - Sonia Mirabet Perez
- Cardiology Department, Hospital de la Santa Creu i Santa Pau and CIBER de Enfermedades Cardiovasculares (CIBER-CV), 08041 Barcelona, Catalonia, Spain;
| | - Eulalia Roig Minguell
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Vicenç Brossa Loidi
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Laura Lopez Lopez
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Sandra Ros Abarca
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Elisabeth Galvez Tugas
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Núria Mas-Malagarriga
- Pharmacy Department, Hospital de la Santa Creu i Santa Pau, 08025 Barcelona, Catalonia, Spain;
| | - Mª Antonia Mangues Bafalluy
- Pharmacy Department, Hospital de la Santa Creu i Santa Pau and CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 08025 Barcelona, Catalonia, Spain;
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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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Kostalova B, Mala-Ladova K, Kubena AA, Horne R, Dusilova Sulkova S, Maly J. Changes in Beliefs About Post-Transplant Immunosuppressants Over Time and Its Relation to Medication Adherence and Kidney Graft Dysfunction: A Follow-Up Study. Patient Prefer Adherence 2021; 15:2877-2887. [PMID: 35002225 PMCID: PMC8725840 DOI: 10.2147/ppa.s344878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 12/07/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The main aim was to evaluate the changes in beliefs about immunosuppressants over a 3-year period in patients after kidney transplantation. The second aim was to investigate the relationship between beliefs, medication adherence, and selected clinical outcomes such as graft functioning. PATIENTS AND METHODS This observational follow-up study was conducted in the outpatient post-transplant clinic at the University Hospital Hradec Kralove in the Czech Republic. Adult patients, at least 4 weeks after kidney transplantation, were invited for the structured interview, which was followed by a self-administered questionnaire survey during their regularly scheduled visits at the clinic. Appropriate paired tests were used to compare two measurements of beliefs about immunosuppressants by BMQ-CZ© in 2016 (baseline) and in 2019 (follow-up). Self-reported adherence was measured by two validated tools (MARS-CZ© and BAASIS©) capturing implementation and discontinuation phases. A generalized linear model was used to investigate the relation between beliefs and the consecutive estimated glomerular filtration rate. RESULTS The study involved 134 patients. Over time, their perceived treatment necessity beliefs of immunosuppressants decreased, while their treatment-related concerns increased. Overall self-reported non-adherence (ie, taking, dosing and discontinuation of immunosuppressants) was reported by 12% of the patients in both observation periods. In the follow-up period, timing non-adherence was reported by 52 (38.8%) patients. Higher baseline treatment concerns were associated with poor adherence whereas higher baseline treatment necessity beliefs corresponded with better kidney functioning, even after adjusting for age. CONCLUSION Higher treatment necessity beliefs corresponded with better kidney functioning, whereas higher treatment concerns were related to non-adherence to immunosuppressants at the beginning of the observed period. Still, most patients accepted their medicines that do not come without risk. Nevertheless, decreasing treatment necessity beliefs on one hand, and increasing treatment concerns on the other, should be considered in clinical practice.
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Affiliation(s)
- Barbora Kostalova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Katerina Mala-Ladova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
- Correspondence: Katerina Mala-Ladova Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Ak. Heyrovskeho 1203/8, Hradec Kralove, 500 05, Czech RepublicTel +420 495 067 486 Email
| | - Ales Antonin Kubena
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Rob Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
| | | | - Josef Maly
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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Sanders-Pinheiro H, Colugnati FAB, Denhaerynck K, Marsicano EO, Medina JOP, De Geest S. Multilevel Correlates of Immunosuppressive Nonadherence in Kidney Transplant Patients: The Multicenter ADHERE BRAZIL Study. Transplantation 2021; 105:255-266. [PMID: 32150041 DOI: 10.1097/tp.0000000000003214] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Immunosuppressive nonadherence is a risk factor for worse outcomes after kidney transplantation (KT). Brazil, having the world's largest public, fully covered transplantation system and the second-highest KT volume worldwide, provides a unique setting for studying multilevel correlates of nonadherence (patient, healthcare provider, transplant center, and healthcare system levels) independent of patients' financial burden. METHODS By applying a multistage sampling approach, we included 1105 patients from 20 KT centers. Nonadherence to immunosuppressives (implementation phase) was defined as any deviation in taking or timing adherence and dose reduction assessed by the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Based on Bronfenbrenner's ecological model, we assessed multilevel factors using established instruments and measures specifically developed for this study and analyzed their independent contribution to nonadherence by performing sequential logistic regression analysis. RESULTS The nonadherence prevalence rate was 39.7%. The following factors were independently associated with nonadherence: Patient level-having a stable partner (odds ratio [OR]: 0.75; confidence interval [CI]: 0.58-0.97), nonadherence to appointments (OR: 2.98; CI: 2.03-4.39), and nonadherence to physical activity recommendations (OR: 1.84; CI: 1.38-2.46); and transplant center level-satisfaction with the waiting room structure (OR: 0.54; CI: 0.42-0.71), consultation >30 minutes (OR: 1.60; CI: 1.19-2.14), adequacy of the consultation frequency (OR: 0.62; CI: 0.43-0.90), and centers with >500 beds (OR: 0.58; CI: 0.46-0.73). CONCLUSIONS As the first multicenter study assessing multilevel correlates of nonadherence in KT, our findings point to the need for multilevel interventions beyond the patient level, targeting transplant center practice patterns as an approach to tackle nonadherence.
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Affiliation(s)
- Helady Sanders-Pinheiro
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Minas Gerais, Brazil and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - Fernando A B Colugnati
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Minas Gerais, Brazil and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - Kris Denhaerynck
- Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Elisa O Marsicano
- Renal Transplantation Unit, University Hospital, Federal University of Juiz de Fora, Minas Gerais, Brazil and Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Minas Gerais, Brazil
| | - José O P Medina
- Hospital do Rim e Hipertensão, Oswaldo Ramos Foundation, Nephrology Discipline, Federal University of São Paulo, São Paulo, Brazil
| | - Sabina De Geest
- Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
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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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Maximo Silva AC, Sanders-Pinheiro H, Leite RF, Joseph MPC, Pestana JOM, Schirmer J, Bartira de Aguiar R. Nonadherence to Immunosuppressive Medications Following Pediatric Kidney Transplantation Within Full Cost Coverage Health System: Prevalence and Correlates. EXP CLIN TRANSPLANT 2020; 18:577-584. [PMID: 33143602 DOI: 10.6002/ect.2020.0101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Pediatric patients are at higher risk of nonadherence to immunosuppressive medication after kidney transplant and the resulting adverse outcomes. Factors associated with nonadherence vary, which follow an epidemiological framework and according to health system patterns. The Brazilian public health system covers all costs of kidney transplant, including immunosuppressive medications. We aimed to assess the prevalence and correlates of nonadherence to immunosuppressive medications in a pediatric kidney transplant population who received free access to immunosuppressive medications within the health care system. MATERIALS AND METHODS In this single-center crosssectional study, we studied a convenience sample of 156 outpatients (< 18 years old) who were a minimum of 4 weeks posttransplant. Implementation nonadherence to immunosuppressive medications was measured by the 4 questions of the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Multilevel correlates to non - adherence (patient, micro, and macro levels) were assessed. RESULTS In our patient population, 61% were males, mean age was 13.6 ± 3.1 years, 77% were adolescents, and 84% received organs from deceased donors. We found that 33% were nonadherent to immuno - suppressive medications, mainly in timing (25%) and taking (10.9%) dimensions. Being an adolescent (odds ratio: 2.66; CI, 1.02-6.96), religion other than Catholic or Protestant (odds ratio: 4.33; CI, 1.13-16.67), and family income higher than 4 reference wages (odds ratio: 3.50; CI, 1.14-10.75) were factors associated with nonadherence. CONCLUSIONS In our patient population of mostly adolescents, one-third displayed nonadherence to immunosuppressants. Unexpectedly, a higher economic profile, potentially representing better previous access to health care, was independently associated with nonadherence. This result highlights the need for identifying specific correlates to non - adherence before designing interventions.
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Affiliation(s)
- Ana Carolina Maximo Silva
- From the Nursing Post-Graduation Program, Paulista School of Nursing, Federal University of São Paulo, São Paulo, Brazil
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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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Ribaut J, Leppla L, Teynor A, Valenta S, Dobbels F, Zullig LL, De Geest S. Theory-driven development of a medication adherence intervention delivered by eHealth and transplant team in allogeneic stem cell transplantation: the SMILe implementation science project. BMC Health Serv Res 2020; 20:827. [PMID: 32878623 PMCID: PMC7465386 DOI: 10.1186/s12913-020-05636-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 08/09/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Medication adherence to immunosuppressants in allogeneic stem cell transplantation (alloSCT) is essential to achieve favorable clinical outcomes (e.g. control of Graft-versus-Host Disease). Over 600 apps supporting medication adherence exist, yet they lack successful implementation and sustainable use likely because of lack of end-user involvement and theoretical underpinnings in their development and insufficient attention to implementation methods to support their use in real-life settings. Medication adherence has three phases: initiation, implementation and persistence. We report the theory-driven development of an intervention module to support medication adherence (implementation and persistence phase) in alloSCT outpatients as a first step for future digitization and implementation in clinical setting within the SMILe project (Development, implementation and testing of an integrated care model in allogeneic SteM cell transplantatIon faciLitated by eHealth). METHODS We applied Michie's Behavior Change Wheel (BCW) and the Capability-Opportunity-Motivation and Behavior (COM-B) model using three suggested stages followed by one stage added by our team regarding preparation for digitization of the intervention: (I) Defining the problem in behavioral terms; (II) Identifying intervention options; (III) Identifying content and implementation options; (IV) SMILe Care Model Prototype Development. Scientific evidence, data from a contextual analysis and patients'/caregivers' and clinical experts' inputs were compiled to work through these steps. RESULTS (I) Correct immunosuppressant taking and timing were defined as target behaviors. The intervention's focus was determined within the COM-B dimensions Capability (lack of knowledge, lack of routine), Opportunity (lack of cues, interruptions in daily routine) and Motivation (lack of problem solving, trivialization). (II) Five intervention functions were chosen, i.e. education, training, modelling, persuasion and enablement. (III) Twenty-four behavior change techniques were selected, e.g., goal setting, action planning and problem solving. (IV) Finally, seventeen user stories were developed to guide the SMILeApp's software development process. CONCLUSION Our example on the theory-driven development of an intervention module in alloSCT delivered by eHealth and transplant team using a rigorous 3 + 1-stage approach based on BCW, COM-B and agile software development techniques, can be used as methodological guidance for other eHealth intervention developers. Our approach has the potential to enhance successful implementation and sustained use of eHealth solutions in real-life settings.
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Affiliation(s)
- Janette Ribaut
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Department of Hematology, University Hospital of Basel, 4031, Basel, Switzerland
| | - Lynn Leppla
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Departments of Hematology, Oncology and Stem Cell Transplantation, University Medical Center Freiburg, 79110, Freiburg im Breisgau, Germany
| | - Alexandra Teynor
- Department of Computer Science, University of Applied Sciences, Augsburg, Germany
| | - Sabine Valenta
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Department of Hematology, University Hospital of Basel, 4031, Basel, Switzerland
| | - Fabienne Dobbels
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, University of Leuven, 3000, Leuven, Belgium
| | - Leah L Zullig
- Department of Population Health Science, Duke University, Durham, NC, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sabina De Geest
- Department Public Health, Faculty of Medicine, Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland. .,Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, University of Leuven, 3000, Leuven, Belgium.
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR. The Approach to the Psychosocial Evaluation of Cardiac Transplant and Mechanical Circulatory Support Candidates. Curr Heart Fail Rep 2020; 16:201-211. [PMID: 31782078 DOI: 10.1007/s11897-019-00443-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW We update evidence underlying the recommendations of a 2018 multi-society consensus report regarding the psychosocial evaluation of individuals for cardiothoracic transplantation and mechanical circulatory support (MCS). In the present review, we focus on heart transplantation and MCS. RECENT FINDINGS Expert opinion and new evidence support the inclusion of ten core content areas in the psychosocial evaluation. Prospective data indicate that psychosocial factors can predict post-transplantation/post-implantation outcomes. Such factors include treatment adherence history, mental health and substance use history, cognitive impairment, knowledge about treatment options, and social factors such as socioeconomic status. For other factors (e.g., coping, social support), new evidence is weaker because it derives largely from cross-sectional studies. Concerning evaluation process issues, expert opinion remains consistent with consensus recommendations, but there is a dearth of empirical evidence. The psychosocial evaluation can identify factors relevant for candidacy for heart transplantation and MCS implantation. It enables the provision of interventions to improve patients' viability as candidates, and facilitates care planning.
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Affiliation(s)
- Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Andrea F DiMartini
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | | | - Kathleen L Grady
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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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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Leppla L, Mielke J, Kunze M, Mauthner O, Teynor A, Valenta S, Vanhoof J, Dobbels F, Berben L, Zeiser R, Engelhardt M, De Geest S. Clinicians and patients perspectives on follow-up care and eHealth support after allogeneic hematopoietic stem cell transplantation: A mixed-methods contextual analysis as part of the SMILe study. Eur J Oncol Nurs 2020; 45:101723. [PMID: 32062362 DOI: 10.1016/j.ejon.2020.101723] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/20/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE We report on our contextual analysis's methodology, as a first step of an implementation science project aiming to develop, implement, and test the effectiveness of an integrated model of care in SteM-cell transplantatIon faciLitated by eHealth (SMILe). METHODS We applied an explanatory sequential mixed-methods design including clinicians and patients of the University Hospital Freiburg, Germany. Data were collected from 3/2017 to 1/2018 via surveys in 5 clinicians and 60 adult allogeneic stem-cell transplantation patients. Subsequently, we conducted 3 clinician focus groups and 10 patient interviews. Data analysis followed a 3-step process: (1) creating narrative descriptions, tables, and maps; (2) mapping key observational findings per dimension of the eHealth-enhanced Chronic-Care Model; (3) reflecting on how findings affect our choice of implementation strategies. RESULTS Current clinical practice is mostly acute care driven, with no interdisciplinarity and weak chronic illness management. Gaps were apparent in the dimensions of self-management support and delivery-system design. Health behaviors that would profit from support include medication adherence, physical activity and infection prevention. The theme "being alone and becoming an expert" underpinned patients need to increase support in hospital-to-home transitions. Patients reported insecurity about recognizing, judging and acting upon symptoms. The theme "eHealth as connection not replacement" underscores the importance of eHealth augmenting, not supplanting human contact. Synthesis of our key observational findings informed eight implementation strategies. CONCLUSION Stakeholders are willing towards a chronic care-focused approach and open for eHealth support. The contextual information provides a basis for the SMILe model's development and implementation.
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Affiliation(s)
- Lynn Leppla
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Juliane Mielke
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland
| | - Maria Kunze
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Department of Psychiatry and Psychotherapy, University of Freiburg, Germany
| | - Oliver Mauthner
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland
| | - Alexandra Teynor
- University of Applied Sciences Augsburg, Faculty of Computer Science, Germany
| | - Sabine Valenta
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Department of Hematology, University Hospital Basel, Switzerland
| | - Jasper Vanhoof
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium; Nursing Center of Excellence, University Psychiatric Center, KU Leuven, Belgium
| | - Fabienne Dobbels
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Lut Berben
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland
| | - Robert Zeiser
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Monika Engelhardt
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, University of Basel, Switzerland; Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Belgium.
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Kocher A, Simon M, Dwyer AA, Villiger PM, Künzler-Heule P, De Geest S, Berben L, Nicca D. Developing a rare disease chronic care model: Management of systemic sclerosis (MANOSS) study protocol. J Adv Nurs 2019; 75:3774-3791. [PMID: 31452216 DOI: 10.1111/jan.14185] [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: 05/24/2019] [Revised: 07/26/2019] [Accepted: 08/13/2019] [Indexed: 12/19/2022]
Abstract
AIM The aim of the management of systemic sclerosis (MANOSS) study described in this protocol is to develop a chronic care model, based on a contextual analysis and stakeholder involvement, for patients living with the rare disease systemic sclerosis (SSc) in Switzerland. DESIGN Applying an implementation science approach, this study starts with an explanatory sequential mixed method study for contextual analysis, followed by broad stakeholder involvement for model development and a Delphi study to reach consensus. METHODS First, a quantitative cross-sectional survey with patients and healthcare professionals (HPs) will be conducted to identify current practice patterns of chronic illness management and technology readiness. Second, qualitative interviews with patients, family members and HPs will be performed to gain a deeper understanding of care needs identified in the quantitative survey. Third, a model of care will be co-created with input from patients, HPs and other experts. The eHealth enhanced Chronic Care Model will serve as a guiding framework. The new model and corresponding outcome parameters will be refined using a Delphi-study approach to reach consensus on a testable model of care for persons living with SSc. The protocol has received research ethics committee approval in September 2018 by the Swiss Ethics Committee. DISCUSSION The MANOSS study's participatory approach is essential for contextual fit of the model for patients with SSc in this setting. Subsequent feasibility testing and implementation are planned to evaluate the model's value in relation to health disparities faced by this patient population. IMPACT Patients living with this rare disease lack access to coordinated, specialized care and self-management support from qualified HPs. Reengineering of current care, with consideration for technological opportunities, is warranted to meet patients' and families' needs.
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Affiliation(s)
- Agnes Kocher
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Rheumatology, Immunology and Allergology, Inselspital Bern University Hospital, Bern, Switzerland
| | - Michael Simon
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Nursing Research Unit, Inselspital Bern University Hospital, Bern, Switzerland
| | - Andrew A Dwyer
- Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Peter M Villiger
- Department of Rheumatology, Immunology and Allergology, Inselspital Bern University Hospital, Bern, Switzerland
| | - Patrizia Künzler-Heule
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Gastroenterology/Hepatology and Department of Nursing Development, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Sabina De Geest
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU-Leuven, Belgium
| | - Lut Berben
- Division of Nursing, Department of Medicine, University Hospital Basel, Basel, Switzerland.,Department of Nursing Development, University Children's Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,University Hospital Basel, Basel, Switzerland
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Danziger-Isakov L, Frazier TW, Worley S, Williams N, Shellmer D, Dharnidharka VR, Gupta NA, Ikle D, Shemesh E, Sweet SC. Perceived barriers to medication adherence remain stable following solid organ transplantation. Pediatr Transplant 2019; 23:e13361. [PMID: 31332928 PMCID: PMC6652201 DOI: 10.1111/petr.13361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/30/2018] [Accepted: 01/04/2019] [Indexed: 12/29/2022]
Abstract
Perceived barriers to adherence have previously been investigated in SOT to identify plausible intervention targets to improve adherence and transplant outcomes. Fifteen centers in CTOTC enrolled patients longitudinally. Patients >8 years completed Adolescent Scale(AMBS) at two visits at least 6 months apart in the first 17 months post-transplant while their guardians completed PMBS. Differences over time for pre-identified AMBS/PMBS factors were analyzed. Perceived barrier reporting impact on subsequent TAC levels was assessed. A total of 123 patients or their guardians completed PMBS or AMBS. Twenty-six were 6-11 years and 97 were ≥12. The final cohort consisted of kidney (66%), lung (19%), liver (8%), and heart (7%) recipients. Unadjusted analysis showed no statistically significant change in reported barriers from visit 1 (median 2.6 months, range 1.2-3.7 post-transplant) to visit 2 (median 12, range 8.9-16.5). Of 102 patients with TAC levels, 74 had a single level reported at both visits. The factor of "Disease frustration" was identified through the PMBS/AMBS questions about fatigue around medication and disease. Each point increase in "disease frustration" at visit 1 on the AMBS/PMBS doubled the odds of a lower-than-threshold TAC level at visit 2. No clear change in overall level of perceived barriers to medication adherence in the first year post-transplant was seen in pediatric SOT. However, disease frustration early post-transplant was associated with a single subtherapeutic TAC levels at 12 months. A brief screening measure may allow for early self-identification of risk.
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Affiliation(s)
| | | | | | - Nikki Williams
- National Institute for Allergy and Infectious Diseases, Bethesda, MD
| | - Diana Shellmer
- University of Pittsburgh, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA
| | - Vikas R. Dharnidharka
- Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
| | | | | | - Eyal Shemesh
- Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Stuart C. Sweet
- Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
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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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Helmy R, Scalso de Almeida S, Denhaerynck K, Berben L, Dobbels F, Russell CL, de Aguiar Roza B, De Geest S. Prevalence of Medication Nonadherence to Co-medication Compared to Immunosuppressants in Heart Transplant Recipients: Findings From the International Cross-sectional BRIGHT Study. Clin Ther 2018; 41:130-136. [PMID: 30591285 DOI: 10.1016/j.clinthera.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 11/07/2018] [Accepted: 11/12/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess and compare the prevalence of medication nonadherence (MNA) (implementation and persistence) to immunosuppressants and co-medications in heart transplant recipients. METHODS MNA prevalence was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (self-report) and compared using logistic regression in a 4-continent sample of 1397 heart transplant recipients from 36 heart transplant centers in 11 countries. FINDINGS MNA was significantly (α = 0.05) higher to co-medications than to immunosuppressants (taking nonadherence: 23.9% vs 17.3%; odds ratio [OR] = 1.5; 95% CI, 1.30-1.73; drug holiday: 5.7% vs 1.9%; OR = 3.17; 95% CI, 2.13-4.73; dose alteration: 3.8% vs 1.6%; OR = 2.46; 95% CI, 1.49-4.06; and discontinuation: 2.6% vs 0.5%; OR = 5.15; 95% CI, 2.36-11.20). IMPLICATIONS The observed MNA necessitates adherence-enhancing interventions encompassing the entire post-heart transplant medication regimen. ClinicalTrials.gov identifier: NCT01608477.
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Affiliation(s)
- Remon Helmy
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Samira Scalso de Almeida
- Hospital Municipal Vila Santa Catarina - Ministério da Saúde PROADI-SUS, São Paulo, Brazil; School of Nursing, Federal University of São Paulo, São Paolo, Brazil
| | - Kris Denhaerynck
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Lut Berben
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland; University 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, MO, USA
| | | | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, 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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48
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Zullig LL, Deschodt M, Liska J, Bosworth HB, De Geest S. Moving from the Trial to the Real World: Improving Medication Adherence Using Insights of Implementation Science. Annu Rev Pharmacol Toxicol 2018; 59:423-445. [PMID: 30125127 DOI: 10.1146/annurev-pharmtox-010818-021348] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Medication nonadherence is a serious public health concern. Although there are promising interventions that improve medication adherence, most interventions are developed and tested in tightly controlled research environments that are dissimilar from the real-world settings where the majority of patients receive health care. Implementation science methods have the potential to facilitate and accelerate the translation shift from the trial world to the real world. We demonstrate their potential by reviewing published, high-quality medication adherence studies that could potentially be translated into clinical practice yet lack essential implementation science building blocks. We further illustrate this point by describing an adherence study that demonstrates how implementation science creates a junction between research and real-world settings. This article is a call to action for researchers, clinicians, policy makers, pharmaceutical companies, and others involved in the delivery of care to adopt the implementation science paradigm in the scale-up of adherence (research) programs.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, North Carolina 27701, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina 27707, USA;
| | - Mieke Deschodt
- Institute of Nursing Science, Department of Public Health, University of Basel, 4056 Basel, Switzerland; .,Division of Gerontology and Geriatrics, Department of Chronic Diseases, Metabolism, and Ageing, KU Leuven, 3000 Leuven, Belgium
| | - Jan Liska
- Patient Solutions Unit, Medical Evidence Generation Team, Sanofi, 75008 Paris, France
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, North Carolina 27701, USA.,Department of Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina 27707, USA;
| | - Sabina De Geest
- Institute of Nursing Science, Department of Public Health, University of Basel, 4056 Basel, Switzerland; .,Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
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49
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Helmy R, Duerinckx N, De Geest S, Denhaerynck K, Berben L, Russell CL, Van Cleemput J, Crespo-Leiro MG, Dobbels F. The international prevalence and variability of nonadherence to the nonpharmacologic treatment regimen after heart transplantation: Findings from the cross-sectional BRIGHT study. Clin Transplant 2018; 32:e13280. [DOI: 10.1111/ctr.13280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Remon Helmy
- Nursing Science; Department of Public Health; Faculty of Medicine; University of Basel; Basel Switzerland
| | - Nathalie Duerinckx
- Academic Centre for Nursing and Midwifery; Department of Public Health and Primary Care; KU Leuven; Leuven Belgium
- Heart Transplant Program; University Hospitals of Leuven; Leuven Belgium
| | - Sabina De Geest
- Nursing Science; Department of Public Health; Faculty of Medicine; University of Basel; Basel Switzerland
- Academic Centre for Nursing and Midwifery; Department of Public Health and Primary Care; KU Leuven; Leuven Belgium
| | - Kris Denhaerynck
- Nursing Science; Department of Public Health; Faculty of Medicine; University of Basel; Basel Switzerland
| | - Lut Berben
- University Hospital of Basel; University of Basel; Basel Switzerland
| | - Cynthia L. Russell
- School of Nursing and Health Studies; University of Missouri-Kansas City; Kansas City MO USA
| | - Johan Van Cleemput
- Heart Transplant Program; University Hospitals of Leuven; Leuven Belgium
| | - Maria G. Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC); CIBERCV; INIBIC; Universidade da Coruña (UDC); La Coruña Spain
| | - Fabienne Dobbels
- Nursing Science; Department of Public Health; Faculty of Medicine; 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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50
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Denhaerynck K, Berben L, Dobbels F, Russell CL, Crespo‐Leiro MG, Poncelet AJ, De Geest S. Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study. Am J Transplant 2018; 18:1447-1460. [PMID: 29205855 PMCID: PMC6001479 DOI: 10.1111/ajt.14611] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/23/2017] [Accepted: 11/19/2017] [Indexed: 01/25/2023]
Abstract
Factors at the level of family/healthcare worker, organization, and system are neglected in medication nonadherence research in heart transplantation (HTx). The 4-continent, 11-country cross-sectional Building Research Initiative Group: Chronic Illness Management and Adherence in Transplantation (BRIGHT) study used multistaged sampling to examine 36 HTx centers, including 36 HTx directors, 100 clinicians, and 1397 patients. Nonadherence to immunosuppressants-defined as any deviation in taking or timing adherence and/or dose reduction-was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale© (BAASIS© ) interview. Guided by the Integrative Model of Behavioral Prediction and Bronfenbrenner's ecological model, we analyzed factors at these multiple levels using sequential logistic regression analysis (6 blocks). The nonadherence prevalence was 34.1%. Six multilevel factors were associated independently (either positively or negatively) with nonadherence: patient level: barriers to taking immunosuppressants (odds ratio [OR]: 11.48); smoking (OR: 2.19); family/healthcare provider level: frequency of having someone to help patients read health-related materials (OR: 0.85); organization level: clinicians reporting nonadherent patients were targeted with adherence interventions (OR: 0.66); pickup of medications at physician's office (OR: 2.31); and policy level: monthly out-of-pocket costs for medication (OR: 1.16). Factors associated with nonadherence are evident at multiple levels. Improving medication nonadherence requires addressing not only the patient, but also family/healthcare provider, organization, and policy levels.
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Affiliation(s)
- Kris Denhaerynck
- Institute of Nursing ScienceDepartment of Public HealthUniversity of BaselBaselSwitzerland
| | - Lut Berben
- Institute of Nursing ScienceDepartment of Public HealthUniversity of BaselBaselSwitzerland
| | - Fabienne Dobbels
- Institute of Nursing ScienceDepartment of Public HealthUniversity of BaselBaselSwitzerland,Academic Centre for Nursing and MidwiferyDepartment of Public Health and Primary CareKU LeuvenLeuvenBelgium
| | - Cynthia L. Russell
- School of Nursing and Health StudiesUniversity of Missouri‐Kansas CityKansas CityMOUSA
| | | | | | - Sabina De Geest
- Institute of Nursing ScienceDepartment of Public HealthUniversity of BaselBaselSwitzerland,Academic Centre for Nursing and MidwiferyDepartment of Public Health and Primary CareKU LeuvenLeuvenBelgium
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