Claes Anouck, Decorte Anneloes, Levtchenko Elena, Knops Noel, Dobbels Fabienne
University of Leuven, Leuven, Belgium.
University Hospitals of Leuven, Leuven, Belgium.
Prog Transplant. 2014 Dec;24(4):311-21. doi: 10.7182/pit2014873.
Many young transplant patients (≤11 years old) struggle to take their immunosuppressive and co-medications correctly, yet it remains unclear which factors positively or negatively affect medication adherence. Research studies on determinants in this age group are scarce, have methodological flaws, and focus exclusively on immunosuppressants or on barriers rather than on facilitators.
This study used a consecutive mixed-methods (qualitative + quantitative) design. Semistructured interviews with parents of 10 pediatric liver or kidney transplant recipients 2 to 11 years old on adherence facilitators and barriers were conducted, complemented by quantification of adherence to the immunosuppressants and co-medications, and completion of the "immunosuppressive medication adherence barriers" self-report instrument.
A median of 19 (range, 10-29) barriers was reported: the most commonly encountered were forgetfulness (70%), vomiting (70%), bad taste (60%), and interruptions in routine (60%). Parents reported a median of 15 facilitators (range, 6-26), including using practical aids (100%), having medication with you at all times (100%), having to take fewer medications (80%), and experiencing fewer regimen changes over time (80%). No clear distinction between immunosuppressants or co-medications was made.
This study provides several new insights based on peer experience to support future patients and their parents in medication adherence.
许多年轻的移植患者（≤11岁）在正确服用免疫抑制剂和辅助药物方面存在困难，但尚不清楚哪些因素对药物依从性有正面或负面影响。关于该年龄组决定因素的研究很少，存在方法学缺陷，并且仅专注于免疫抑制剂或障碍而非促进因素。
本研究采用连续混合方法（定性+定量）设计。对10名2至11岁的小儿肝或肾移植受者的父母进行了关于依从性促进因素和障碍的半结构化访谈，并辅以免疫抑制剂和辅助药物依从性的量化，以及完成“免疫抑制药物依从性障碍”自我报告工具。
报告的障碍中位数为19（范围10-29）：最常见的是健忘（70%）、呕吐（70%）、味道差（60%）和日常安排中断（60%）。父母报告的促进因素中位数为15（范围6-26），包括使用实用辅助工具（100%）、随时携带药物（100%）、需要服用的药物较少（80%）以及随着时间推移方案变化较少（80%）。免疫抑制剂和辅助药物之间没有明显区别。
本研究基于同行经验提供了一些新见解，以支持未来患者及其父母的药物依从性。
