Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Transplantation. 2012 May 15;93(9):958-63. doi: 10.1097/TP.0b013e31824b822d.
Nonadherence to immunosuppressant medication is a significant problem among solid organ transplant recipients. Previous research suggests that patients' perceptions about their medications may be a better predictor of nonadherence than demographic factors. This study aimed to further investigate the role of patients' perceptions about their transplant and medication beliefs in nonadherence.
This was a cross-sectional observational study. Participants were 87 heart, 46 lung, and 193 liver transplant patients. All surviving heart, lung, and liver transplant patients from Auckland City Hospital and Greenlane Hospital older than 16 years who had received their transplant at least 3 months before study commencement were mailed questionnaires. Standardized self-report measures were used to assess illness perceptions, medication beliefs, and adherence.
Nonadherent patients had lower perceptions about the necessity of medication, weaker beliefs that medication could prevent rejection, and higher concerns about its harms, than adherers. Nonadherers perceived that their transplant and immunosuppressant medication caused more symptoms and were more distressed about symptoms than adherers; they understood their transplant less, perceived their transplant had a larger impact on their lives, affected them more emotionally, and caused greater concern, than patients who were more adherent. A regression model that included these perceptions and demographic variables correctly classified 71% of patients as adherent or nonadherent.
The perceptions that patients hold about their transplant and medications are associated with adherence to immunosuppressant medications. Future research could investigate whether a psychologic intervention could change patients' perceptions to improve adherence.
器官移植受者免疫抑制剂用药依从性差是一个严重的问题。既往研究提示，患者对药物的认知可能比人口统计学因素更能预测用药依从性。本研究旨在进一步探讨患者对移植和药物信念的认知在用药依从性中的作用。
这是一项横断面观察性研究。研究对象为 87 例心脏、46 例肺和 193 例肝移植患者。所有在奥克兰市医院和格林兰医院接受心脏、肺和肝移植且年龄大于 16 岁的患者，只要在研究开始前至少 3 个月就已经接受了移植，均邮寄问卷。采用标准化的自报式量表评估疾病认知、药物信念和用药依从性。
与依从者相比，不依从者对药物的必要性认知更低，对药物预防排斥反应的信念更弱，对药物不良反应的顾虑更高。不依从者认为移植和免疫抑制剂导致更多的症状，且对症状感到更苦恼，与依从者相比，他们对移植的理解更差，认为移植对生活的影响更大，对他们的情绪影响更大，引起的顾虑更多；他们对移植的认知更差，认为移植对生活的影响更大，对他们的情绪影响更大，引起的顾虑更多。一个纳入这些认知和人口统计学变量的回归模型能正确地将 71%的患者分类为依从者或不依从者。
患者对移植和药物的认知与免疫抑制剂的用药依从性相关。未来的研究可以探索心理干预是否可以改变患者的认知，以提高依从性。
