De Geest S, Borgermans L, Gemoets H, Abraham I, Vlaminck H, Evers G, Vanrenterghem Y
School of Public Health, Department of Medical Social Sciences, Catholic University of Leuven, Belgium.
Transplantation. 1995 Feb 15;59(3):340-7.
In this descriptive cross-sectional study, we investigated the incidence, determinants, and consequences of subclinical noncompliance with immunosuppressive therapy in 150 adult renal transplant recipients with more than one year posttransplant status. Symptom frequency and symptom distress, and self-care agency were measured by the Transplant Symptom Frequency and Symptom Distress Scale, and the Appraisal for Self-Care Agency Scale, respectively. The Long-Term Medication Behavior Self-Efficacy Scale and a renal transplant knowledge questionnaire were developed as part of this study to measure perceived self-efficacy and knowledge of the therapeutic regimen. Demographic variables were also measured. The incidence of subclinical noncompliance with immunosuppressive therapy as assessed by interview was 22.3%. Compliers and noncompliers differed significantly on the variables of marital status (P = 0.03), situational-operational knowledge (P = 0.02), self-care agency (P = 0.03), and perceived self-efficacy related to long-term medication intake (P = 0.048). A logistic regression model using gender, marital status, perceived self-efficacy, self-care agency, knowledge about medication administration and signs of infection, and situational operational knowledge as predictor variables, revealed a 78.6% correct classification of compliers versus noncompliers and a sensitivity ratio of 95.9%. There were significantly more acute late rejection episodes (P = 0.003) in the noncompliant group. Graft survival at 5 years in this group was also significantly lower (P = 0.03) than the compliant patients. No significant difference was found in terms of the occurrence of chronic rejection episodes or in terms of patient survival at 5 years. Because noncompliance is a risk factor for negative clinical outcome in renal transplant recipients, it is of utmost importance to develop intervention strategies to enhance compliance in this population by using determinants identified in exploratory studies.
在这项描述性横断面研究中，我们调查了150例移植后状态超过一年的成年肾移植受者亚临床免疫抑制治疗不依从的发生率、决定因素及后果。症状频率、症状困扰以及自我护理能力分别通过移植症状频率和症状困扰量表以及自我护理能力评估量表进行测量。作为本研究的一部分，还开发了长期用药行为自我效能量表和肾移植知识问卷，以测量感知到的自我效能和对治疗方案的了解。同时也测量了人口统计学变量。通过访谈评估的亚临床免疫抑制治疗不依从发生率为22.3%。依从者和不依从者在婚姻状况（P = 0.03）、情景操作知识（P = 0.02）、自我护理能力（P = 0.03）以及与长期用药相关的感知自我效能（P = 0.048）等变量上存在显著差异。使用性别、婚姻状况、感知自我效能、自我护理能力、用药管理和感染迹象的知识以及情景操作知识作为预测变量的逻辑回归模型显示，对依从者与不依从者的正确分类率为78.6%，敏感度为95.9%。不依从组的急性晚期排斥反应发作显著更多（P = 0.003）。该组5年时的移植物存活率也显著低于依从患者（P = 0.03）。在慢性排斥反应发作的发生率或5年患者存活率方面未发现显著差异。由于不依从是肾移植受者不良临床结局的一个危险因素，利用探索性研究中确定的决定因素制定干预策略以提高该人群的依从性至关重要。
