title: Medication understanding, non-adherence, and clinical outcomes among adult kidney transplant recipients.
abstract: We sought to evaluate the prevalence of medication understanding and non-adherence of entire drug regimens among kidney transplantation (KT) recipients and to examine associations of these exposures with clinical outcomes. Structured, in-person interviews were conducted with 99 adult KT recipients between 2011 and 2012 at two transplant centers in Chicago, IL; and Atlanta, GA. Nearly, one-quarter (24%) of participants had limited literacy as measured by the Rapid Estimate of Adult Literacy in Medicine test; patients took a mean of 10 (SD=4) medications and 32% had a medication change within the last month. On average, patients knew what 91% of their medications were for (self-report) and demonstrated proper dosing (via observed demonstration) for 83% of medications. Overall, 35% were non-adherent based on either self-report or tacrolimus level. In multivariable analyses, fewer months since transplant and limited literacy were associated with non-adherence (all P<.05). Patients with minority race, a higher number of medications, and mild cognitive impairment had significantly lower treatment knowledge scores. Non-white race and lower income were associated with higher rates of hospitalization within a year following the interview. The identification of factors that predispose KT recipients to medication misunderstanding, non-adherence, and hospitalization could help target appropriate self-care interventions.
authors.affiliation: Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA. rpatzer@emory.edu.|Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA, USA. rpatzer@emory.edu.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Patzer
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Marina
authors.initials: M
authors.lastname: Serper
authors.affiliation: Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Reese
authors.affiliation: Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Kamila
authors.initials: K
authors.lastname: Przytula
authors.affiliation: Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Koval
authors.affiliation: Comprehensive Transplant Center (CTC), Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Daniela P
authors.initials: DP
authors.lastname: Ladner
authors.affiliation: Comprehensive Transplant Center (CTC), Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Josh M
authors.initials: JM
authors.lastname: Levitsky
authors.affiliation: Comprehensive Transplant Center (CTC), Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Abecassis
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University School of Medicine, Chicago, IL, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D032882:Comprehension; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D057566:Self Report; D000073278:Self-Management / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D007166:Immunosuppressive Agents
keywords: cognition; hospitalization; kidney transplantation; literacy; medication adherence