title: Non-adherence to immunosuppressive medications in kidney transplantation: intent vs. forgetfulness and clinical markers of medication intake.
abstract: BACKGROUND
  Although adherence to immunosupressive medication after transplantation is important to maximize good clinical outcomes it remains suboptimal and not well-understood. The purpose of this study was to examine intentional and unintentional non-adherence to immunosuppression medication in kidney transplant patients.
  
  
  METHODS
  A cross-sectional sample of N=218 patients [49.6 ± 12.3 years] recruited in London, UK (1999-2002) completed measures of medication beliefs, quality-of-life, depression, and transplantation-specific emotions. Adherence was measured with self-report and serial immunosuppressive assays.
  
  
  RESULTS
  Intentional non-adherence was low (13.8 %) yet 62.4 % admitted unintentional non-adherence and 25.4 % had sub-target immunosuppressive levels. The risk of sub-target serum immunosuppressive levels was greater for patients admitting unintentional non-adherence (OR=8.4; p=0.004). Dialysis vintage, doubts about necessity, and lower worry about viability of graft explained R(2)=16.1 to 36 % of self-report non-adherence. Depression was related only to intentional non-adherence.
  
  
  CONCLUSIONS
  Non-adherence is common in kidney transplantation. Efforts to increase adherence should be implemented by targeting necessity beliefs, monitoring depression, and promoting strategies to decrease forgetfulness.
authors.affiliation: Department of Psychology, National University of Singapore, 9 Arts Link AS402/28, Singapore, Singapore. psygk@nus.edu.sg
authors.forename: Konstadina
authors.initials: K
authors.lastname: Griva
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
authors.forename: Michael
authors.initials: M
authors.lastname: Harrison
authors.forename: Stanton P
authors.initials: SP
authors.lastname: Newman
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D033182:Intention; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008568:Memory; D008875:Middle Aged; D063046:Patient Medication Knowledge; D011788:Quality of Life; D057566:Self Report
chemical_list: D007166:Immunosuppressive Agents