title: Kidney transplant patients' perceptions, beliefs, and barriers related to regular nephrology outpatient visits.
abstract: BACKGROUND
  Our previous work has shown substantial national variation in the frequency of nephrology visits after kidney transplant. The low frequency of nephrology visits was associated with increased risk of transplant failure.
  
  
  METHODS
  We performed a qualitative study that included interviews and 5 focus groups of transplant recipients. The study took place at a transplant center in the Upper Midwest. Participants (N = 39) were selected if they had at least one of the previously described risk factors for decreased nephrology visits: ethnic minority, lower median household income, and residence less than 10 miles from the transplant center. The goal was to assess patients' perceptions and beliefs and perceived barriers to regular nephrology outpatient visits. All transcripts were coded using software for qualitative data analysis.
  
  
  RESULTS
  Transplant recipients understood the importance of keeping nephrology appointments and reflected positively on them. Regardless, they perceived barriers to adhering to the visit schedule, such as a value on self-reliance, which they described as increasing over time since transplant; a growing sense that they could interpret their bodies independently without needing to see the physician as regularly; and finally, the multitude of physical and mental health challenges inherent to posttransplant life. Other factors motivated patients to keep their regular nephrology visits, such as peer-support relationships and talking to other patients on dialysis therapy. Patients reported that talking to patients who had received a transplant before them helped them anticipate and cope with the mental and physical challenges associated with life posttransplant. A study limitation was that all participants were from a single transplant center.
  
  
  CONCLUSIONS
  Although kidney transplant recipients understood the importance of keeping nephrology appointments, there were significant perceived barriers to these visits. Future interventions should address perceived barriers and motivate patients to keep regular nephrology visits posttransplant as a way to improve transplant outcomes.
authors.affiliation: Department of Family Medicine/Community Health, University of Minnesota, Minneapolis, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Goldade
authors.forename: Sonal
authors.initials: S
authors.lastname: Sidhwani
authors.forename: Sagar
authors.initials: S
authors.lastname: Patel
authors.forename: Lisa
authors.initials: L
authors.lastname: Brendt
authors.forename: Jennifer
authors.initials: J
authors.lastname: Vigliaturo
authors.forename: Bertram
authors.initials: B
authors.lastname: Kasiske
authors.forename: Jasjit S
authors.initials: JS
authors.lastname: Ahluwalia
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Israni
mesh_terms: D000553:Ambulatory Care / Q000523:psychology* / Q000706:statistics & numerical data; D001290:Attitude; D003266:Continuity of Patient Care; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016030:Kidney Transplantation / Q000523:psychology*; D008297:Male; D009398:Nephrology; D010361:Patients / Q000523:psychology*; D010465:Perception; D012959:Socioeconomic Factors