Lennerling Annette, Forsberg Anna
Transplant Institute, Sahlgrenska University Hospital, Bruna Straket 5, 6 floor, 413 45 Gothenburg, Sweden.
Open Nurs J. 2012;6:41-6. doi: 10.2174/1874434601206010041. Epub 2012 Apr 4.
Patients' non-adherence to immunosuppressant treatment after organ transplantation may lead to organ failure, graft loss and death. Non-adherence among Swedish kidney transplant recipients has not previously been studied. Hence the aim of this study was to explore non-adherence among Swedish kidney transplant recipients by using self-report instruments as well as testing the hypothesis that there is a difference in self-reported symptoms, beliefs about medicine and social support between respondents with or without self reported non-adherence.
In the present cross sectional study 250 renal transplant recipients participated by replying to a questionnaire. Two validated instruments were included, one on beliefs about medicine (the BMQ©), the other on nonadherence (the BAASIS©).
Only 46 % never failed to follow the medical treatment with respect to taking the drugs, dosage or timing (>2 hrs from prescribed time). Timing was the most frequently reported deviation (48 %). Forty-seven patients (16 %) had failed taking at least one dose of the prescribed immunosuppressants during the past four weeks. Four individuals had reduced the prescribed doses. Only one reported taking a 'drug holiday'. Nine participants reported stronger concerns than necessities for immunosuppressive medication. For the BMQ the necessity scores were extremely high while the scores for concern were low. Risk behaviour identified by the BAASIS had no association in risk attitudes as identified in the BMQ. The only factor relating to non-adherence was lack of social support (p=0.022).
In general adherence was high. Identification of the exceptions remains a challenge.
器官移植后患者不坚持免疫抑制治疗可能导致器官衰竭、移植物丢失和死亡。瑞典肾移植受者的不依从情况此前尚未得到研究。因此，本研究的目的是通过使用自我报告工具来探索瑞典肾移植受者的不依从情况，并检验以下假设：自我报告有或没有不依从情况的受访者在自我报告的症状、对药物的信念和社会支持方面存在差异。
在本横断面研究中，250名肾移植受者通过回复问卷参与研究。纳入了两种经过验证的工具，一种是关于对药物的信念（BMQ©），另一种是关于不依从情况（BAASIS©）。
在服药、剂量或时间方面（比规定时间晚>2小时），只有46%的患者从未不遵守医疗治疗。时间是最常报告的偏差（48%）。在过去四周内，有47名患者（16%）至少有一次未服用规定的免疫抑制剂。有4人减少了规定剂量。只有1人报告有“药物假期”。9名参与者报告对免疫抑制药物的担忧多于需求。对于BMQ，需求得分极高而担忧得分较低。BAASIS确定的风险行为与BMQ确定的风险态度无关。与不依从相关的唯一因素是缺乏社会支持（p = 0.022）。
总体而言依从性较高。识别出例外情况仍然是一个挑战。
