Pill burden does not influence compliance with oral medication in recipients of renal transplant.
Pill burden does not influence compliance with oral medication in recipients of renal transplant.
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DOI：
10.4103/0253-7613.174425
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发表时间：
2016-01
影响因子：
2.4
通讯作者：
Das T
中科院分区：
文献类型：
--
作者：
Adhikari UR;Taraphder A;Hazra A;Das T
洞察不依从性的预测因素是在给定的治疗情况下制定依从性增强策略的关键。肾移植是一项重要的外科手术，给患者带来了很大的药物负担。有一种怀疑是，巨大的药物负担可能导致不遵守规定。我们的目的是确定在印度社会文化背景下，药丸负担对肾移植患者服药依从性的影响。一项纵向观察研究在加尔各答的两家三级护理医院进行，这些医院分别来自政府和私营部门的肾移植项目。通过有目的的抽样，共招募120名识字的成人移植受者，每隔3个月随访1年。数据收集通过访谈和审查处方和医疗记录。对110例受试者的资料进行分析。在政府部门，出院后不久首次就诊时药丸负担为10-21（中位数14），12个月最后一次就诊时药丸负担为7-22（中位数11）；私营机构的相应数字为14-32（中值21）和10-28（中值17）。服药负担随年龄增长而增加。只有60.91%的患者在移植后1年完全适应。政府部门免疫抑制剂不合规率为27.78%，私营部门为25.00%。中位药丸负担与服药依从性之间无显著关联。对照顾者支持的满意度与更好的免疫抑制剂依从性相关。肾移植受者不遵医嘱可能是多因素的。与普遍的看法相反，药物负担并不是不服从行为的主要决定因素。
Insights about the predictors of noncompliance are key to develop compliance enhancing strategy in a given therapeutic situation. Renal transplantation is a critical surgical procedure that imposes a large medication burden on patients. There is a suspicion that the large pill burden may lead to noncompliance. Our objective was to ascertain the influence of pill burden on medication compliance in renal transplant patients in the Indian sociocultural context. A longitudinal observational study was conducted in two Tertiary Care Hospitals in Kolkata running renal transplant program – one each from the government and private sectors. Totally 120 literate adult transplant recipients were recruited through purposive sampling and followed up at 3 months intervals for 1 year. Data were collected through interview and review of prescriptions and medical records. Data of 110 subjects were analyzed. The pill burden was high – ranging from 10-21 (median 14) at first visit shortly after discharge to 7–22 (median 11) at last visit at 12 months in the government sector; corresponding figures in the private sector were 14–32 (median 21) and 10–28 (median 17). Pill burden increased with age. Only 60.91% of the patients were fully compliant until 1 year after transplantation. The rate of immunosuppressant noncompliance was 27.78% in government sector and 25.00% in private sector. There was no significant association between median pill burden and medication compliance. Satisfaction with caregiver support was associated with better immunosuppressant compliance. Noncompliance in renal transplant recipients is likely to be multifactorial. Contrary to popular belief, pill burden was not a major determinant of noncompliant behavior.