Zelikovsky Nataliya, Schast Aileen P, Palmer JoAnn, Meyers Kevin E C
Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA.
Pediatr Transplant. 2008 May;12(3):300-8. doi: 10.1111/j.1399-3046.2007.00886.x. Epub 2008 Jan 7.
Non-adherence to medical regimens is a ubiquitous hindrance to quality health care among adolescent transplant recipients. Identification of potentially modifiable barriers to adherence when patients are listed for organ transplant would help with early intervention efforts to prepare adolescents for the stringent medication regimen post-transplant. Fifty-six adolescents listed for a kidney transplant, mean age 14.27 (s.d. = 2.2; range 11-18 yr), 73.2% male, 62.5% Caucasian participated in a semi-structured interview, the Medical Adherence Measure, to assesses the patient's knowledge of the prescribed regimen, reported adherence (missed and late doses), the system used to organized medications, and who holds the primary responsibility over medication management. Better knowledge of the medication regimen was associated with fewer missed doses (r = -0.48, p < 0.001). Patients who perceived more barriers had more missed (r = 0.38, p = 0.004) and late (r = 0.47, p < 0.001) doses. Patients who endorsed "just forget," the most common barrier (56.4%), reported significantly more missed (z = -4.25, p < 0.001) and late (z = -2.2, p = 0.02) doses. Only one-third of the transplant candidates used a pillbox to organize medications but these patients had significantly better adherence, z = -2.2, p = 0.03. With regard to responsibility over managing the regimens, adolescents missed fewer doses when their parents were in charge than when they were solely responsible, z = -2.1, p = 0.04. Interventions developed to prepare transplant candidates for a stringent post-transplant regimen need to focus on ensuring accurate knowledge of as simple a regimen as possible. Use of an organized system such as a pillbox to establish a routine and facilitate tracking of medications is recommended with integration of reminders that may be appealing for this age group. Although individuation is developmentally normative at this age, parent involvement seems critical until the adolescent is able to manage the responsibility more independently.
不遵守医疗方案是青少年移植受者获得优质医疗保健的普遍障碍。在患者被列入器官移植名单时，识别可能可改变的依从性障碍，将有助于早期干预，使青少年为移植后严格的药物治疗方案做好准备。56名等待肾移植的青少年参与了一项半结构化访谈——“医疗依从性测量”，这些青少年平均年龄为14.27岁（标准差=2.2；年龄范围11 - 18岁），73.2%为男性，62.5%为白种人。该访谈旨在评估患者对规定治疗方案的了解、报告的依从情况（漏服和迟服剂量）、用于整理药物的系统以及谁对药物管理负主要责任。对药物治疗方案了解得更好与漏服剂量更少相关（r = -0.48，p < 0.001）。认为障碍更多的患者漏服（r = 0.38，p = 0.004）和迟服（r = 0.47，p < 0.001）剂量更多。认可“只是忘记了”这一最常见障碍（56.4%）的患者，报告的漏服（z = -4.25，p < 0.001）和迟服（z = -2.2，p = 0.02）剂量显著更多。只有三分之一的移植候选人使用药盒来整理药物，但这些患者的依从性明显更好，z = -2.2，p = 0.03。关于治疗方案管理的责任，当父母负责时青少年漏服剂量比他们独自负责时更少，z = -2.1，p = 0.04。为使移植候选人准备好接受严格的移植后治疗方案而制定的干预措施需要专注于确保对尽可能简单的治疗方案有准确的了解。建议使用药盒等有组织的系统来建立常规并便于追踪药物，并结合可能吸引该年龄组的提醒措施。尽管在这个年龄个性化发展是正常的，但在青少年能够更独立地承担责任之前，父母的参与似乎至关重要。
