title: Prevalence and risk factors of non-adherence with immunosuppressive medication in kidney transplant patients.
abstract: Non-adherence with immunosuppressive regimen is a major risk factor for poor outcome after kidney transplantation. Identifying patients at risk for non-adherence requires understanding the risk factors for non-adherence. This prospective study included a convenience sample of 249 adult kidney transplant patients >1 year post-transplant. Non-adherence was monitored electronically using MEMS(R). Selected socio-economic, therapy-, patient-, condition- and healthcare team-related risk factors for non-adherence were assessed. Period prevalences were expressed as the percent of prescribed doses taken (taking adherence), the percent of correctly dosed days (dosing adherence), the percentage of inter-dose intervals not exceeding 25% of the prescribed interval (timing adherence), and the number of drug holidays per 100 days (no intake for > 48 h if once daily or for > 24 h if twice daily intake). Testing occurred by simple mixed logistic regression analysis. Factors significant after correction for multiple testing were entered into a multiple logistic regression model. Mean taking, dosing, timing adherence, and drug holidays were 98%, 96%, 93%, and 1.1 days, respectively. Non-adherence was associated with lower self-efficacy, higher self-reported non-adherence, no pillbox usage, and male gender. Adherence declined between Monday and Sunday. This study provides a framework for identifying patients at risk for non-adherence and for developing adherence-enhancing interventions.
authors.affiliation: Institute of Nursing Science, University of Basel & Clinical Nursing Science, University Hospital Basel, Switzerland.
authors.forename: K
authors.initials: K
authors.lastname: Denhaerynck
authors.forename: J
authors.initials: J
authors.lastname: Steiger
authors.forename: A
authors.initials: A
authors.lastname: Bock
authors.forename: P
authors.initials: P
authors.lastname: Schäfer-Keller
authors.forename: S
authors.initials: S
authors.lastname: Köfer
authors.forename: N
authors.initials: N
authors.lastname: Thannberger
authors.forename: S
authors.initials: S
authors.lastname: De Geest
mesh_terms: D000328:Adult; D000368:Aged; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016312:Treatment Refusal / Q000706:statistics & numerical data*
chemical_list: D007166:Immunosuppressive Agents