title: Pill burden does not influence compliance with oral medication in recipients of renal transplant.
abstract: OBJECTIVE
  Insights about the predictors of noncompliance are key to develop compliance enhancing strategy in a given therapeutic situation. Renal transplantation is a critical surgical procedure that imposes a large medication burden on patients. There is a suspicion that the large pill burden may lead to noncompliance. Our objective was to ascertain the influence of pill burden on medication compliance in renal transplant patients in the Indian sociocultural context.
  
  
  METHODS
  A longitudinal observational study was conducted in two Tertiary Care Hospitals in Kolkata running renal transplant program - one each from the government and private sectors. Totally 120 literate adult transplant recipients were recruited through purposive sampling and followed up at 3 months intervals for 1 year. Data were collected through interview and review of prescriptions and medical records.
  
  
  RESULTS
  Data of 110 subjects were analyzed. The pill burden was high - ranging from 10-21 (median 14) at first visit shortly after discharge to 7-22 (median 11) at last visit at 12 months in the government sector; corresponding figures in the private sector were 14-32 (median 21) and 10-28 (median 17). Pill burden increased with age. Only 60.91% of the patients were fully compliant until 1 year after transplantation. The rate of immunosuppressant noncompliance was 27.78% in government sector and 25.00% in private sector. There was no significant association between median pill burden and medication compliance. Satisfaction with caregiver support was associated with better immunosuppressant compliance.
  
  
  CONCLUSIONS
  Noncompliance in renal transplant recipients is likely to be multifactorial. Contrary to popular belief, pill burden was not a major determinant of noncompliant behavior.
authors.affiliation: Woodlands College of Nursing, Bishnupur, South 24 Parganas, India.
authors.forename: Uma Rani
authors.initials: UR
authors.lastname: Adhikari
authors.affiliation: Department of Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Taraphder
authors.affiliation: Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: Avijit
authors.initials: A
authors.lastname: Hazra
authors.affiliation: Department of Medicine, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: Tapas
authors.initials: T
authors.lastname: Das
mesh_terms: D000284:Administration, Oral; D019983:Guideline Adherence; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D010349:Patient Compliance
chemical_list: D007166:Immunosuppressive Agents
keywords: Compliance; India; pill burden; renal transplant