title: Measuring compliance with drug regimens after renal transplantation: comparison of self-report and clinician rating with electronic monitoring.
abstract: Nonadherence to immunosuppressants in renal transplant recipients is a major factor affecting graft survival, but it is difficult to detect accurately in clinical practice. Adherence was measured in 153 adult renal transplant recipients using self-report questionnaires and interview, clinician rating, and cyclosporine levels. The sensitivity and specificity of these measures were determined by comparison with electronic monitoring in a randomly selected subsample of 58 subjects. Measures of adherence in current clinical use do not perform well when tested against electronic monitoring. Self-report at a confidential interview was the best measure of adherence for the detection of both missed doses and erratic timing of medication. However, the use of a confidential interview is not directly applicable to a clinical setting. Further research on how best to facilitate disclosure in clinical settings may be the best way to develop adherence measures for use in routine practice.
authors.affiliation: University Mental Health Group, Royal South Hants Hospital, Southampton, United Kingdom.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Butler
authors.forename: Robert C
authors.initials: RC
authors.lastname: Peveler
authors.forename: Paul
authors.initials: P
authors.lastname: Roderick
authors.forename: Robert
authors.initials: R
authors.lastname: Horne
authors.forename: Juan C
authors.initials: JC
authors.lastname: Mason
mesh_terms: D000328:Adult; D016572:Cyclosporine / Q000008:administration & dosage* / Q000097:blood; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000097:blood; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012646:Self Administration; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine