Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Rotman School of Management, University of Toronto, Ontario, Canada.
Clin Transplant. 2023 Jun;37(6):e14962. doi: 10.1111/ctr.14962. Epub 2023 Mar 23.
Medication non-adherence contributes to post-transplant graft rejection and failure; however, limited knowledge about the reasons for non-adherence hinders the development of interventions to improve adherence. We conducted focus groups with solid organ transplant recipients regarding overlooked challenges in the process of transplant medication self-management and examined their adherence strategies and perceptions towards the post-transplant medication regimen.
We conducted four focus groups with n = 31 total adult transplant recipients. Participants had received kidney, liver, or combined liver/kidney transplant at Johns Hopkins Hospital between 2014 and 2019. Focus groups were audio-recorded and transcribed. Transcripts were analyzed inductively, using the constant comparative method.
Responses generally fell into two major categories: (1) barriers to adherence and (2) "adherence landscape". We define the former as factors directly labeled as barriers to adherence by participants and the latter as factors that heavily influence the post-transplant medication self-management process.
We propose a shift in the way healthcare providers and researchers, address the question of medication non-adherence. Rather than asking why patients are non-adherent, we suggest that constructing and understanding patients' "adherence landscape" will provide an optimal way to align the goals of patients and providers and boost health outcomes.
药物不依从会导致移植后移植物排斥和衰竭；然而，由于对不依从原因的了解有限，阻碍了开发改善依从性的干预措施。我们对实体器官移植受者进行了焦点小组讨论，讨论了移植药物自我管理过程中被忽视的挑战，并研究了他们的依从策略以及对移植后药物治疗方案的看法。
我们对 n=31 名成年移植受者进行了 4 个焦点小组讨论。参与者于 2014 年至 2019 年期间在约翰霍普金斯医院接受了肾、肝或肝/肾联合移植。对焦点小组进行了录音和转录。使用恒定比较法对转录本进行了归纳分析。
回答通常分为两大类：（1）依从性障碍和（2）“依从性环境”。我们将前者定义为参与者直接标记为依从性障碍的因素，后者定义为严重影响移植后药物自我管理过程的因素。
我们建议医疗保健提供者和研究人员改变解决药物不依从问题的方式。与其问患者为什么不依从，我们建议构建和理解患者的“依从性环境”将为协调患者和提供者的目标并提高健康结果提供最佳途径。
