Adhikari U R, Taraphder A, Hazra A, Das T
Government College of Nursing, Burdwan, India.
Department of Nephrology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.
Indian J Nephrol. 2017 Jul-Aug;27(4):294-300. doi: 10.4103/0971-4065.202835.
Medication nonadherence is a known problem after renal transplantation and can vary from one setting to another. Since it can lead to negative outcomes, it is important to develop intervention strategies to enhance adherence in a given setting using determinants identified through exploratory studies. We explored nonadherence in renal transplant recipients. A longitudinal survey was done with adult renal transplant recipients at a tertiary care public and two private hospitals of Kolkata. Subjects were followed-up for 1 year. After screening for medication adherence status by the four-item Morisky Medication Adherence Scale, those admitting to potential nonadherence were probed further. A patient was deemed to be nonadherent if failing to take medicines on appointed time (doses missed or delayed by more than 2 h) more than three times in any month during the observation period. A pretested questionnaire was used to explore potential determinants of nonadherence. Data of 153 patients recruited over a 2-year were analyzed. The extent of nonadherence with immunosuppressant regimens was about 31% overall; 44% in the public sector and 19% in the private sector ( < 0.001). Nonadherence with other medication was around 19% in both the sectors. Several potential demographic, socioeconomic and psychosocial determinants of nonadherence were identified on univariate analysis. However, logistic regression analysis singled out only the economic status. This study had updated the issue of nonadherence in renal transplant recipients in the Indian setting. Strategies to improve medication adherence can be planned by relevant stakeholders on the basis of these findings.
肾移植后药物治疗依从性不佳是一个已知问题，且在不同环境中可能有所不同。由于它可能导致负面后果，利用探索性研究确定的决定因素来制定干预策略以提高特定环境下的依从性很重要。我们对肾移植受者的不依从情况进行了探索。在加尔各答的一家三级护理公立医院和两家私立医院，对成年肾移植受者进行了纵向调查。对受试者进行了1年的随访。通过四项Morisky药物治疗依从性量表筛查药物治疗依从性状况后，对那些承认可能不依从的受试者进行了进一步调查。在观察期内，如果患者在任何一个月内未按时服药（漏服或延迟服药超过2小时）超过三次，则被视为不依从。使用一份经过预测试的问卷来探索不依从的潜在决定因素。对在两年内招募的153名患者的数据进行了分析。免疫抑制剂治疗方案的总体不依从率约为31%；公共部门为44%，私营部门为19%（<0.001）。两个部门中其他药物的不依从率均约为19%。单因素分析确定了几个不依从的潜在人口统计学、社会经济和心理社会决定因素。然而，逻辑回归分析仅确定了经济状况。这项研究更新了印度背景下肾移植受者不依从的问题。相关利益相关者可根据这些研究结果制定提高药物治疗依从性的策略。
