Investigating barriers to immunosuppressant medication adherence in renal transplant patients
Investigating barriers to immunosuppressant medication adherence in renal transplant patients
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DOI：
10.1111/nep.13214
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发表时间：
2019-01-01
期刊：
影响因子：
2.5
通讯作者：
Cottrell, William Neil
中科院分区：
文献类型：
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作者：
Cossart, Amelia Rose;Staatz, Christine Elizabeth;Cottrell, William Neil
目的免疫抑制剂治疗不依从可导致移植物排斥和丢失。本研究的目的是调查成人肾移植队列中免疫抑制剂药物不依从性的患病率和依从性障碍。方法采用巴塞尔免疫抑制药物依从性评估量表（BAASIS）、药物信念问卷、免疫抑制剂治疗障碍量表、简易疾病认知问卷和多维健康控制源量表对肾移植受者进行问卷调查，并提供社会人口学资料。根据BAASIS对依从性进行分类，并比较两组间的依从性障碍。结果161例患者完成问卷调查。86名参与者（55%）被归类为非依从性，45%延迟剂量，25%跳过剂量。不依从的患者更容易忘记剂量（P = 0.005），当他们的日常生活发生变化时（P < 0.001）或缺钱时（P = 0.03）更容易跳过剂量。此外，非依从性患者自我报告的对移植物的了解少于依从性患者（P = 0.008）。依从性与患者的医学信念或对控制点的感知无关。结论超过一半的患者自我报告不依从。导致不依从的主要可修改障碍是健忘和跳过剂量。针对习惯形成的个性化干预可能会提高这一人群的依从性。
Aim Immunosuppressant medication non-adherence can result in allograft rejection and loss. The aim of this study was to investigate the prevalence of non-adherence and barriers to adherence with immunosuppressant medications, in an adult renal transplant cohort. Methods Kidney transplant recipients completed a self-report survey consisting of five validated questionnaires (Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS), Beliefs about Medicines Questionnaire, Immunosuppressant Therapy Barrier Scale, Brief-Illness Perception Questionnaire, and Multidimensional Health Locus of Control Scale), and provided sociodemographic information. Adherence was categorised according to BAASIS, with adherence barriers compared between the groups. Results One hundred and sixty-one patients in total completed the survey. Eighty-six participants (55%) were categorised as non-adherent, with 45% delaying doses, and 25% skipping doses. Non-adherent patients were more likely to forget doses (P = 0.005), and more likely to skip doses when their daily routine changed (P < 0.001) or when short of money (P = 0.03). Additionally, non-adherent patients had less self-reported understanding about their graft than adherent patients (P = 0.008). Adherence was not associated with a patient's medicine beliefs or perception of locus of control. Conclusion Over half the patients self-reported non-adherence. The main modifiable barriers leading to non-adherence were forgetfulness and skipped doses. Personalised interventions focused on habit forming may improve adherence in this population.