There is increasing awareness that patient behavior in view of nonadherence (NA) to the therapeutic regimen after transplantation is an important yet not well substantiated risk factor for poor graft and patient survival. We report the results of a single-center, cross-sectional study on the prevalence and determinants of NA among consenting, maintenance liver transplant (LT) recipients. Inclusion criteria called for adult, de novo LT, single-organ, and Italian native speaking recipients. NA was measured by means of structured questionnaires and collateral reports of the transplant physicians. Self reporting included the Basel Assessment of Compliance with Immunosuppressive Medication Scale (BAASIS), the Visual Analog Scale (VAS BAASIS), and the Immunosuppressive Therapy Adherence Instrument (ITAS). Patients’ attitudes, intentions and normative beliefs towards immunosuppression (IS) were measured by a recently developed instrument consisting of health beliefs that proved to be related to NA in adherence research in transplantation or that were identifi ed in qualitative research as important hindrances to adherence. Self-effi cacy expectations were measured by an adapted version of the Long-Term Medication Behavior Self-Effi cacy Scale (LTMBSES). Out of 368 potentially eligible candidates, 311 satisfi ed the inclusion criteria and were contacted. Two hundred sixty-eight of them (86.1%) responded to the questionnaires and were available for the current analysis (male-to-female ratio 207:61; mean age 54.4 ± 8.9 years). Altogether, 89 patients (33.2%) recalled an episode of NA over the previous 4 weeks, either as skipping one dose of IS, not taking IS exactly as prescribed, or lowering the dose of IS. Nonadherers showed statistically signifi cant weaker intentions (p =0.003) with no difference in terms of attitudes and/or normative beliefs. Prevalence of NA among adult, maintenance LT recipients is about 33% even in the setting of a National-Health-run care delivery system and we suggest nonadherer profi ling with the illustrated questionnaires to allow for continued improvement of clinical results in LT.
Measuring adherence in adult liver transplant patients
De Simone P;Filipponi F
2009-01-01
Abstract
There is increasing awareness that patient behavior in view of nonadherence (NA) to the therapeutic regimen after transplantation is an important yet not well substantiated risk factor for poor graft and patient survival. We report the results of a single-center, cross-sectional study on the prevalence and determinants of NA among consenting, maintenance liver transplant (LT) recipients. Inclusion criteria called for adult, de novo LT, single-organ, and Italian native speaking recipients. NA was measured by means of structured questionnaires and collateral reports of the transplant physicians. Self reporting included the Basel Assessment of Compliance with Immunosuppressive Medication Scale (BAASIS), the Visual Analog Scale (VAS BAASIS), and the Immunosuppressive Therapy Adherence Instrument (ITAS). Patients’ attitudes, intentions and normative beliefs towards immunosuppression (IS) were measured by a recently developed instrument consisting of health beliefs that proved to be related to NA in adherence research in transplantation or that were identifi ed in qualitative research as important hindrances to adherence. Self-effi cacy expectations were measured by an adapted version of the Long-Term Medication Behavior Self-Effi cacy Scale (LTMBSES). Out of 368 potentially eligible candidates, 311 satisfi ed the inclusion criteria and were contacted. Two hundred sixty-eight of them (86.1%) responded to the questionnaires and were available for the current analysis (male-to-female ratio 207:61; mean age 54.4 ± 8.9 years). Altogether, 89 patients (33.2%) recalled an episode of NA over the previous 4 weeks, either as skipping one dose of IS, not taking IS exactly as prescribed, or lowering the dose of IS. Nonadherers showed statistically signifi cant weaker intentions (p =0.003) with no difference in terms of attitudes and/or normative beliefs. Prevalence of NA among adult, maintenance LT recipients is about 33% even in the setting of a National-Health-run care delivery system and we suggest nonadherer profi ling with the illustrated questionnaires to allow for continued improvement of clinical results in LT.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
