title: Medicine non-adherence in kidney transplantation.
abstract: BACKGROUND
  The increasing prevalence of chronic kidney disease, the relative shortage of kidney donors and the economic- and health-related costs of kidney transplant rejection make the prevention of adverse outcomes following transplantation a healthcare imperative. Although strict adherence to immunosuppressant medicine regimens is key to preventing kidney rejection, evidence suggests that adherence is sub-optimal. Strategies need to be developed to help recipients of kidney transplants adhere to their prescribed medicines.
  
  
  RESULTS
  This review has found that a number of factors contribute to poor adherence, for example, attitudes towards medicine taking and forgetfulness. Few investigations have been conducted, however, on strategies to enhance medicine adherence in kidney transplant recipients. Strategies that may improve adherence include pharmacist-led interventions (incorporating counselling, medicine reviews and nephrologist liaison) and nurse-led interventions (involving collaboratively working with recipients to understand their routines and offering solutions to improve adherence). Strategies that have shown to have limited effectiveness include supplying medicines free of charge and providing feedback on a participant's medicine adherence without any educational or behavioural interventions.
  
  
  CONCLUSIONS
  Transplantation is the preferred treatment option for people with end-stage kidney disease. Medicine non-adherence in kidney transplantation increases the risk of rejection, kidney loss and costly treatments. Interventions are needed to help the transplant recipient take all their medicines as prescribed to improve general well-being, medicine safety and reduce healthcare costs.
authors.affiliation: School of Nursing and Midwifery, Monash University, Frankston, Victoria, Australia.
authors.forename: Allison Fiona
authors.initials: AF
authors.lastname: Williams
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Manias
authors.forename: Cadeyrn J
authors.initials: CJ
authors.lastname: Gaskin
authors.forename: Kimberley
authors.initials: K
authors.lastname: Crawford
mesh_terms: D001294:Attitude to Health; D003299:Cooperative Behavior; D006084:Graft Rejection / Q000451:nursing* / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D033183:Interdisciplinary Communication; D016030:Kidney Transplantation / Q000451:nursing* / Q000523:psychology*; D055118:Medication Adherence / Q000523:psychology*; D009723:Nurse-Patient Relations
chemical_list: D007166:Immunosuppressive Agents
keywords: Immunosuppression; Nursing, Self-management/self-care, Transplantation