title: Factors predictive of medication nonadherence after renal transplantation:  a French observational study.
abstract: BACKGROUND
  There have been few prospective studies on the natural history of nonadherence (NA) in kidney transplant recipients (KTRs) over time. The objective of this study was to prospectively evaluate the rate of and risk factors for NA in a French cohort of KTRs.
  
  
  METHODS
  A total of 312 KTRs from eight French transplantation centers were included in this prospective, noninterventional cohort study. A computer-learning software package (the Organ Transplant Information System) was made available to all patients.
  
  
  RESULTS
  Using the four-item Morisky scale, we showed that 17.3%, 24.1%, 30.7%, and 34.6% of patients were nonadherent at posttransplant month 3 (M3), M6, M12, and M24, respectively. Young age was predictive of NA at M6, M12, and M24. Surprisingly, simple treatment regimens including a small number of doses per day and a small number of tablets per day were associated with NA at M3 and M12, respectively. Other factors predictive of NA included failure to use the Organ Transplant Information System software package at M6 and patient reports of adverse events at M12 and M24. Importantly, we observed that physicians underestimated the prevalence of adverse events when compared to patient self-reporting.
  
  
  CONCLUSIONS
  Our observed rate of medication NA in France is consistent with rates reported in previous studies. We found variability in NA risk factors over time as well as an unexpected risk factor (simple treatment regimens). These findings will be useful in developing effective adherence-promoting interventions.
authors.affiliation: CHU de Bordeaux, Hôpital Pellegrin, Service de Néphrologie et Transplantation Rénale, Bordeaux, France. lionel.couzi@chu-bordeaux.fr
authors.forename: Lionel
authors.initials: L
authors.lastname: Couzi
authors.forename: Bruno
authors.initials: B
authors.lastname: Moulin
authors.forename: Marie-Pascale
authors.initials: MP
authors.lastname: Morin
authors.forename: Laetitia
authors.initials: L
authors.lastname: Albano
authors.forename: Michel
authors.initials: M
authors.lastname: Godin
authors.forename: Benoit
authors.initials: B
authors.lastname: Barrou
authors.forename: Eric
authors.initials: E
authors.lastname: Alamartine
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Morelon
authors.forename: Sandrine
authors.initials: S
authors.lastname: Girardot-Seguin
authors.forename: Laurence
authors.initials: L
authors.lastname: Mendes
authors.forename: David
authors.initials: D
authors.lastname: Misdrahi
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Cassuto
authors.forename: Pierre
authors.initials: P
authors.lastname: Merville
mesh_terms: D000328:Adult; D000367:Age Factors; D001292:Attitude to Computers; D016009:Chi-Square Distribution; D003194:Computer-Assisted Instruction; D005260:Female; D005602:France; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D063005:Health Information Systems; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology*; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D010353:Patient Education as Topic; D011446:Prospective Studies; D012307:Risk Factors; D012984:Software; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents