Adherence to immunosuppressor medication in renal transplanted patients

Table 1 Health effects of non-adherence[2]

Increased morbidity

Treatment failures

Exacerbation of disease

More frequent physician visits

Increased hospitalizations

Decreased HRQoL

Decreased survival

Death

Economic impact: lost wages, sick time

HRQoL: Health-related quality of life.

Table 2 Interventions categories[2]

More instruction of patients

Counseling about target disease, compliance with therapy, side-effects

Automated telephone, computer-assisted patient monitoring and counseling

Manual telephone

Family interventions

Increasing convenience of care

Simplified dosing

Different formulations

Self-monitoring strategies

Reminders

Dose-dispensing units/charts

Appointments and refill reminders

Reinforcement or rewards for improved adherence in reduced frequency of visits

Crisis intervention

Direct observation

Lay health mentoring

Comprehensive pharmaceutical care

Psychological therapy

Table 3 Factors associated with non-adherence to immunosuppressive therapy

Age of patients: Younger (specially adolescent) and older patients (> 55 yr)

Gender: Male (or female), not having a female partner

Socioeconomics and cultural: Poor health coverage, poor health access, costs of treatment, difficulty in transportation, poor social support, unmarried, no family, non caucasian, inmigrant, lack of general education and specific education about renal transplantation, lower income, lower socioeconomic class, poor socioeconomic background, greater parental distress and lower family cohesion in family functioning

Medication: Complex medical regimens, higher number of drugs, longer post-transplant, toxicity and side effects, poor tolerance of medication, higher number of doctors, poor provider-patient rapport, patient implicitly seen as defaulter

Psychological: Psychological (dependency, high levels of anxiety and hostility; in children, poorer behavioral functioning and greater distress) and psychiatric illness (depression), low self-efficacy with med intake, perceptions of immunosuppressive therapy as not needed to keep the kidney, significant positive relationship between pre-tx non-adherence and post-tx non-adherence (past behaviour predicts future behaviour), evolution of disease is a matter of chance, forgetfulness, rebelliousness, poor perception of health, poor satisfaction, low health-related quality of life, addictions, lack of coping strategies and avoidance behavior

Patient morbidity: Comorbidity, receiving a transplant from a live donor, retransplant, non-insulin-dependent diabetes

Other: No research, opportunities for improving adherence through optimizing the health care system or training the health care work remain hidden