Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
370797Institute for Public Health and Medicine - Center for Applied Health Research on Aging, Northwestern University, Chicago, IL, USA.
Prog Transplant. 2022 Sep;32(3):226-232. doi: 10.1177/15269248221107041. Epub 2022 Jun 10.
Many kidney recipients struggle with medication adherence and are at greater risk for adverse post-transplant outcomes. Historically, research has focused on single immunosuppressants alone, though all medications within a prescribed regimen are essential for positive outcomes. Explore predictors of medication regimen nonadherence among a diverse sample of adult kidney recipients by using multiple measures of adherence. A cross-sectional analysis was performed using data from an ongoing clinical trial that enrolled 234 kidney recipients from a large transplant center. We used linear and logit regression models to examine associations of demographic characteristics, social determinants of health, and clinical characteristics with (a) self-reported regimen adherence, measured by the Adherence Starts with Knowledge 12 scale, and (b) immunosuppressant adherence, captured by calculated risk score based on Tacrolimus measurements. Kidney recipients with limited health literacy, overall poorer health, and higher levels of depression demonstrated significantly poorer regimen adherence. Recipients who had dual public/private insurance, took a greater number of medications, and had shorter time since transplant demonstrated significantly poorer immunosuppressant adherence. Social determinants (health literacy and insurance status), and clinical characteristics (overall health status, depression, number of medications, and time since transplant) played significant roles in regimen and immunosuppressant adherence among kidney recipients in our sample. Self-reported adherence, particularly in relation to full medication regimens, can highlight modifiable barriers that might otherwise be overlooked by focusing on adherence to a single immunosuppressant. Depression and health literacy can be assessed and addressed to improve adherence among adult kidney recipients.
许多肾脏接受者在服用药物方面存在困难，并且发生移植后不良后果的风险更高。从历史上看，研究主要集中在单一免疫抑制剂上，尽管处方方案中的所有药物对积极的结果都很重要。通过使用多种药物依从性测量方法，探索了一个多样化的成年肾脏接受者样本中药物治疗方案不依从的预测因素。对来自大型移植中心的 234 名肾脏接受者进行了一项正在进行的临床试验的数据进行了横断面分析。我们使用线性和逻辑回归模型来研究人口统计学特征、健康的社会决定因素和临床特征与(a)自我报告的治疗方案依从性（通过 Adherence Starts with Knowledge 12 量表测量）和(b)免疫抑制剂依从性（通过基于 Tacrolimus 测量的计算风险评分捕获）之间的关联。具有有限健康素养、总体健康状况较差和抑郁程度较高的肾脏接受者表现出明显较差的治疗方案依从性。具有双重公共/私人保险、服用更多药物和移植后时间较短的接受者表现出明显较差的免疫抑制剂依从性。社会决定因素（健康素养和保险状况）和临床特征（总体健康状况、抑郁、服用药物的数量和移植后时间）在我们样本中的肾脏接受者的治疗方案和免疫抑制剂依从性中起着重要作用。自我报告的依从性，特别是与完整的药物治疗方案有关，可能会突出一些可能会被忽视的可修改的障碍，而这些障碍如果只关注单一免疫抑制剂的依从性则可能会被忽视。可以评估和解决抑郁和健康素养问题，以提高成年肾脏接受者的依从性。
