title: Physician reported adherence to immunosuppressants in renal transplant patients: Prevalence, agreement, and correlates.
abstract: OBJECTIVE
  Adherence to immunosuppressants (IS) is crucial to prevent allograft rejection. Even though there is evidence that non-adherence to IS among kidney transplant recipients is common, it is rarely routinely assessed in clinical practice. Especially, little is known about how physicians estimate patients' adherence to IS medication.
  
  
  METHODS
  In a single center, cross-sectional study adult patients at least 1 year after kidney transplantation were asked to complete measures of adherence (BAASIS©, Transplant Effect Questionnaire) and of general psychopathology (anxiety, depression, perceived social support). Also the physicians were asked to estimate their patients' adherence. Medical data (time since transplantation, treatment for rejection, IS serum trough levels and target levels) were taken from the patients' charts.
  
  
  RESULTS
  Physicians rated 22 of 238 (9.2%) patients as non-adherent. Physicians' estimations of non-adherence were lower compared to the results of the self-ratings and biopsy-proven rejections. No association was found between physicians' estimates and the variability of IS through levels. Significantly more women and patients who reported that their native language was not German were rated as non-adherent by the physicians. Also, physician-rated non-adherent patients reported significantly higher depression and anxiety scores as well as less social support compared to adherent patients.
  
  
  CONCLUSIONS
  Our results suggest that physicians tend to underestimate patient non-adherence to IS medication. They appear to use observable cues such as sex, language skills, and elevated anxiety and depression scores in particular, to make inferences about an individual patient's adherence. Underestimation of medication non-adherence may impede physicians' ability to provide high quality care.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Germany.
authors.forename: Selma
authors.initials: S
authors.lastname: Pabst
authors.affiliation: Department of Nephrology and Hypertension, Hannover Medical School, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Bertram
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Zimmermann
authors.affiliation: Department of Nephrology and Hypertension, Hannover Medical School, Germany.
authors.forename: Mario
authors.initials: M
authors.lastname: Schiffer
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Germany. Electronic address: dezwaan.martina@mh-hannover.de.
authors.forename: Martina
authors.initials: M
authors.lastname: de Zwaan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D007802:Language; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D010820:Physicians; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012737:Sex Factors; D012944:Social Support; D011795:Surveys and Questionnaires; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D007166:Immunosuppressive Agents
keywords: Immunosuppression; Kidney transplantation; Medication adherence