Non-Adherence to immunosuppressive medications in kidney transplantation: Intent Vs. forgetfulness and clinical markers of medication intake

Abstract

Background Although adherence to immunosupressive medication after transplantation is important to maximize good clinical outcomes it remains suboptimal and not wellunderstood. The purpose of this study was to examine intentional and unintentional non-Adherence to immunosuppression medication in kidney transplant patients. Methods A cross-sectional sample of N0218 patients [49.6± 12.3 years] recruited in London, UK (1999-2002) completed measures of medication beliefs, quality-of-life, depression, and transplantation- specific emotions. Adherence was measured with self-report and serial immunosuppressive assays. Results Intentional non-Adherence was low (13.8 %) yet 62.4 % admitted unintentional non-Adherence and 25.4 % had sub-target immunosuppressive levels. The risk of subtarget serum immunosuppressive levels was greater for patients admitting unintentional non-Adherence (OR08.4; p=0.004). Dialysis vintage, doubts about necessity, and lower worry about viability of graft explained R 2016.1 to 36 % of self-report non-Adherence. Depression was related only to intentional non-Adherence. Conclusions Non-Adherence is common in kidney transplantation. Efforts to increase adherence should be implemented by targeting necessity beliefs, monitoring depression, and promoting strategies to decrease forgetfulness. © The Society of Behavioral Medicine 2012.