title: Rurality and other factors associated with adherence to immunosuppressant medications in community-dwelling solid-organ transplant recipients.
abstract: BACKGROUND
  Data on immunosuppressant adherence of community-dwelling adult solid-organ transplant recipients (SOTRs) from rural populations in the United States are limited. Therefore, understanding the association of rurality and other factors of immunosuppressant adherence will help providers design and deliver patient-centered adherence enhancing interventions.
  
  
  OBJECTIVE
  The objective was to examine factors associated with a previously validated 4-item Immunosuppressant Therapy Adherence Scale (ITAS) score in community-dwelling adult SOTRs who received a transplant from an academic center in the Midwestern United States.
  
  
  METHODS
  For this observational study, cross-sectional survey data (patient demographic, medical condition, immunosuppressant therapy, and self-reported ITAS) received from adult SOTRs aged 19 years or older with other data from an academic transplant center's database were merged. Using multivariate logistic regression, significant SOTR characteristics associated with being adherent (ITAS score=12) versus nonadherent (ITAS score <12) were examined.
  
  
  RESULTS
  The survey response rate was 30% (n=556/1827). Those SOTRs responding (n=556) had a kidney (48%), liver (47%), or other (4.5%) transplant. They were more likely to be 50- to 64-year olds (52%), men (55%), white (90%), metroresident (59%), with an annual income less than $55,000. The SOTRs were living with a transplant for 6.3 years (median), reported excellent-to-good health status (77%), and received different immunosuppressant regimens. More than half of the SOTRs (58%) were adherent. In multivariate analyses, compared with patients aged 65 years or older, younger patients, nonmetro rural- versus metroresident, and those having more (≥6) versus less (<6) comorbidities were significantly less likely to report adherence. SOTRs receiving tacrolimus-based combination immunosuppressant versus tacrolimus alone were more likely to report adherence.
  
  
  CONCLUSIONS
  When designing and delivering patient care-centered interventions including those that use technology to increase immunosuppressant adherence, providers need to consider rural residence besides other well-established patient factors (younger age, immunosuppressant drug, and comorbidities) of nonadherence.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE 68198-6045, USA. jsankara@unmc.edu
authors.forename: Jayashri
authors.initials: J
authors.lastname: Sankaranarayanan
authors.forename: Dean
authors.initials: D
authors.lastname: Collier
authors.forename: Anne
authors.initials: A
authors.lastname: Furasek
authors.forename: Tom
authors.initials: T
authors.lastname: Reardon
authors.forename: Lynette M
authors.initials: LM
authors.lastname: Smith
authors.forename: Megan
authors.initials: M
authors.lastname: McCartan
authors.forename: Alan N
authors.initials: AN
authors.lastname: Langnas
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003157:Community Pharmacy Services; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015146:Midwestern United States; D016017:Odds Ratio; D016377:Organ Transplantation / Q000009:adverse effects; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D019035:Rural Health Services; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents