Killian Michael O
School of Social Work, University of Texas at Arlington, Arlington, TX, USA.
Pediatr Transplant. 2017 Jun;21(4). doi: 10.1111/petr.12899. Epub 2017 Feb 15.
Few studies have identified the psychosocial characteristics of those children and their families associated with future non-adherence to immunosuppressive medications following a heart or lung transplant. UNOS data and medical records information were used to test the association between patient and family psychosocial characteristics and medication adherence. Medication adherence outcomes were obtained using the physician assessments in the UNOS data and measured through patient-level standard deviation scores of immunosuppressive medication blood levels. Complete data were collected on 105 pediatric heart and lung transplant recipients and their families. Multivariate, stepwise analyses were conducted with each adherence outcome. Physician reports of adherence were associated with age of the child at transplantation, parental education, two-parent families, significant psychosocial problems, and the pretransplant life support status of the child. The resulting model (χ =28.146, df=5, P<.001) explained approximately 39.5% of the variance in physician reports of adherence (Nagelkerke r =.395). Blood level standard deviation scores were predicted by age at transplant (F=5.624, P=.02, r =.05). Results point to the difficulties experienced by children and families when undergoing a heart or lung transplantation. Efforts to develop standardized and evidence-based pretransplant psychosocial assessments in pediatric populations are suggested, especially those surrounding familial risk factors.
很少有研究确定那些儿童及其家庭的心理社会特征与心脏或肺移植后未来不坚持服用免疫抑制药物之间的关联。利用器官共享联合网络（UNOS）的数据和病历信息来检验患者及家庭心理社会特征与药物依从性之间的关联。药物依从性结果是通过UNOS数据中的医生评估获得的，并通过免疫抑制药物血药浓度的患者水平标准差分数来衡量。收集了105名小儿心脏和肺移植受者及其家庭的完整数据。对每个依从性结果进行了多变量逐步分析。医生报告的依从性与移植时儿童的年龄、父母教育程度、双亲家庭、严重的心理社会问题以及儿童移植前的生命支持状态有关。所得模型（χ =28.146，自由度=5，P<.001）解释了医生报告的依从性差异的约39.5%（Nagelkerke r =.395）。血药浓度标准差分数由移植时的年龄预测（F=5.624，P=.02，r =.05）。结果表明儿童和家庭在接受心脏或肺移植时所经历的困难。建议努力在儿科人群中开展标准化的、基于证据的移植前心理社会评估，尤其是围绕家庭风险因素的评估。
