title: Attitudes to medication after kidney transplantation and their association with medication adherence and graft survival: a 2-year follow-up study.
abstract: Background. Nonadherence to medication is a common problem after kidney transplantation. The aim of this study was to explore attitudes towards medication, adherence, and the relationship with clinical outcomes. Method. Kidney recipients participated in a Q-methodological study 6 weeks after transplantation. As a measure of medication adherence, respondents completed the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS(©)-interview). Moreover, the intrapatient variability in the pharmacokinetics of tacrolimus was calculated, which measures stability of drug intake. Data on graft survival was retrieved from patient records up to 2 years after transplantation. Results. 113 renal transplant recipients (19-75 years old) participated in the study. Results revealed three attitudes towards medication adherence-attitude 1: "confident and accurate," attitude 2: "concerned and vigilant," and attitude 3: "appearance oriented and assertive." We found association of attitudes with intrapatient variability in pharmacokinetics of tacrolimus, but not with self-reported nonadherence or graft survival. However, self-reported nonadherence immediately after transplantation was associated with lower two-year graft survival. Conclusion. These preliminary findings suggest that nonadherence shortly after kidney transplantation may be a risk factor for lower graft survival in the years to follow. The attitudes to medication were not a risk factor.
authors.affiliation: Department of Internal Medicine, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Mirjam
authors.identifier: 0000-0001-9389-184X
authors.initials: M
authors.lastname: Tielen
authors.affiliation: Institute of Health Policy & Management (iBMG), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
authors.forename: Job
authors.identifier: 0000-0002-4178-1777
authors.initials: J
authors.lastname: van Exel
authors.affiliation: Department of Internal Medicine, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Mirjam
authors.identifier: 0000-0002-4514-1814
authors.initials: M
authors.lastname: Laging
authors.affiliation: Department of Internal Medicine, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Denise K
authors.initials: DK
authors.lastname: Beck
authors.affiliation: Department of Internal Medicine, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Roshni
authors.initials: R
authors.lastname: Khemai
authors.affiliation: Department of Internal Medicine, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands ; Department of Hospital Pharmacy, Erasmus Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Teun
authors.initials: T
authors.lastname: van Gelder
authors.affiliation: Department of Internal Medicine, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Michiel G H
authors.initials: MG
authors.lastname: Betjes
authors.affiliation: Department of Internal Medicine, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Weimar
authors.affiliation: Department of Internal Medicine, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Emma K
authors.initials: EK
authors.lastname: Massey