Denhaerynck K, Steiger J, Bock A, Schäfer-Keller P, Köfer S, Thannberger N, De Geest S
Institute of Nursing Science, University of Basel & Clinical Nursing Science, University Hospital Basel, Switzerland.
Am J Transplant. 2007 Jan;7(1):108-16. doi: 10.1111/j.1600-6143.2006.01611.x. Epub 2006 Nov 15.
Non-adherence with immunosuppressive regimen is a major risk factor for poor outcome after kidney transplantation. Identifying patients at risk for non-adherence requires understanding the risk factors for non-adherence. This prospective study included a convenience sample of 249 adult kidney transplant patients >1 year post-transplant. Non-adherence was monitored electronically using MEMS(R). Selected socio-economic, therapy-, patient-, condition- and healthcare team-related risk factors for non-adherence were assessed. Period prevalences were expressed as the percent of prescribed doses taken (taking adherence), the percent of correctly dosed days (dosing adherence), the percentage of inter-dose intervals not exceeding 25% of the prescribed interval (timing adherence), and the number of drug holidays per 100 days (no intake for > 48 h if once daily or for > 24 h if twice daily intake). Testing occurred by simple mixed logistic regression analysis. Factors significant after correction for multiple testing were entered into a multiple logistic regression model. Mean taking, dosing, timing adherence, and drug holidays were 98%, 96%, 93%, and 1.1 days, respectively. Non-adherence was associated with lower self-efficacy, higher self-reported non-adherence, no pillbox usage, and male gender. Adherence declined between Monday and Sunday. This study provides a framework for identifying patients at risk for non-adherence and for developing adherence-enhancing interventions.
肾移植术后不坚持免疫抑制方案是导致不良预后的主要风险因素。识别有不坚持治疗风险的患者需要了解导致不坚持治疗的风险因素。这项前瞻性研究纳入了249例移植后1年以上的成年肾移植患者的便利样本。使用MEMS（R）电子监测不坚持治疗的情况。评估了选定的社会经济、治疗、患者、病情和医疗团队相关的不坚持治疗风险因素。期间患病率以服用的规定剂量百分比（服药依从性）、正确给药天数百分比（给药依从性）、给药间隔不超过规定间隔25%的百分比（时间依从性）以及每100天的停药天数（每日一次服药时无摄入超过48小时，或每日两次服药时无摄入超过24小时）来表示。通过简单的混合逻辑回归分析进行检验。在多重检验校正后具有显著性的因素被纳入多重逻辑回归模型。平均服药、给药、时间依从性和停药天数分别为98%、96%、93%和1.1天。不坚持治疗与自我效能较低、自我报告的不坚持治疗程度较高、未使用药盒以及男性性别相关。周一至周日期间依从性下降。本研究为识别有不坚持治疗风险的患者以及制定增强依从性的干预措施提供了一个框架。
