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Immunosuppressive therapy related adherence, beliefs and self-management in kidney transplant outpatients

PURPOSE: Kidney transplant (KTx) recipients should strictly adhere to their lifelong complex therapeutic regimen, and any barriers to medication adherence can weaken correct patient behavior. This study aimed to determine the adherence to immunosuppressive therapy (IS) in KTx adult outpatients in th...

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Autores principales: Vankova, Barbora, Mala-Ladova, Katerina, Kubena, Ales Antonin, Maly, Josef, Sulkova, Sylvie Dusilova
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287542/
https://www.ncbi.nlm.nih.gov/pubmed/30584284
http://dx.doi.org/10.2147/PPA.S184166
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author Vankova, Barbora
Mala-Ladova, Katerina
Kubena, Ales Antonin
Maly, Josef
Sulkova, Sylvie Dusilova
author_facet Vankova, Barbora
Mala-Ladova, Katerina
Kubena, Ales Antonin
Maly, Josef
Sulkova, Sylvie Dusilova
author_sort Vankova, Barbora
collection PubMed
description PURPOSE: Kidney transplant (KTx) recipients should strictly adhere to their lifelong complex therapeutic regimen, and any barriers to medication adherence can weaken correct patient behavior. This study aimed to determine the adherence to immunosuppressive therapy (IS) in KTx adult outpatients in the Czech Republic, and attempted to gain a greater insight into their attitudes toward IS and self-management tasks. MATERIALS AND METHODS: Pharmacist-led structured interviews were conducted to assess self-reported adherence to IS using the Czech version of the Medication Adherence Report Scale, in the context of attitudes toward IS in terms of necessity and concern scale of the Beliefs about Medicines Questionnaire. A specific questionnaire was developed to target IS self-management tasks. Medication records were also reviewed for IS serum levels, reflecting direct adherence measurement. Descriptive statistics were used to calculate adherence and self-management variables, and were analyzed by univariate and multivariate correlations, including the decision-tree method. RESULTS: The interview was completed by 211 (male 123; mean age 55.0±12.4 years, mean time 6.6±5.9 years after KTx) of the total of 235 patients. Full adherence to IS was reported by 173 (82.0%) patients. Most of them had IS serum levels within the therapeutic range, however, cyclosporine was associated with the highest variability (P<0.001). Non-adherence and concerns increased over time after KTx (P<0.05). Despite the more common unintentional non-adherence (P<0.001), relatively high concerns signified the risk of not taking IS as prescribed. Concerns also correlated with the perception of impaired health status (P<0.01), as well as the occurrence of IS-related adverse effects (P<0.001). The patients’ awareness of their therapy was insufficient, and main gaps in self-management comprised inadequate sun protection, incorrect administration of IS, and unfamiliarity with the IS name, or their indications. CONCLUSION: Although self-reported adherence to IS therapy was satisfactory, the comprehensive evaluation enabled the detection of greater concerns about IS, as well as underestimated self-management tasks that posttransplant interventions should target in the future.
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spelling pubmed-62875422018-12-24 Immunosuppressive therapy related adherence, beliefs and self-management in kidney transplant outpatients Vankova, Barbora Mala-Ladova, Katerina Kubena, Ales Antonin Maly, Josef Sulkova, Sylvie Dusilova Patient Prefer Adherence Original Research PURPOSE: Kidney transplant (KTx) recipients should strictly adhere to their lifelong complex therapeutic regimen, and any barriers to medication adherence can weaken correct patient behavior. This study aimed to determine the adherence to immunosuppressive therapy (IS) in KTx adult outpatients in the Czech Republic, and attempted to gain a greater insight into their attitudes toward IS and self-management tasks. MATERIALS AND METHODS: Pharmacist-led structured interviews were conducted to assess self-reported adherence to IS using the Czech version of the Medication Adherence Report Scale, in the context of attitudes toward IS in terms of necessity and concern scale of the Beliefs about Medicines Questionnaire. A specific questionnaire was developed to target IS self-management tasks. Medication records were also reviewed for IS serum levels, reflecting direct adherence measurement. Descriptive statistics were used to calculate adherence and self-management variables, and were analyzed by univariate and multivariate correlations, including the decision-tree method. RESULTS: The interview was completed by 211 (male 123; mean age 55.0±12.4 years, mean time 6.6±5.9 years after KTx) of the total of 235 patients. Full adherence to IS was reported by 173 (82.0%) patients. Most of them had IS serum levels within the therapeutic range, however, cyclosporine was associated with the highest variability (P<0.001). Non-adherence and concerns increased over time after KTx (P<0.05). Despite the more common unintentional non-adherence (P<0.001), relatively high concerns signified the risk of not taking IS as prescribed. Concerns also correlated with the perception of impaired health status (P<0.01), as well as the occurrence of IS-related adverse effects (P<0.001). The patients’ awareness of their therapy was insufficient, and main gaps in self-management comprised inadequate sun protection, incorrect administration of IS, and unfamiliarity with the IS name, or their indications. CONCLUSION: Although self-reported adherence to IS therapy was satisfactory, the comprehensive evaluation enabled the detection of greater concerns about IS, as well as underestimated self-management tasks that posttransplant interventions should target in the future. Dove Medical Press 2018-12-06 /pmc/articles/PMC6287542/ /pubmed/30584284 http://dx.doi.org/10.2147/PPA.S184166 Text en © 2018 Vankova et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Vankova, Barbora
Mala-Ladova, Katerina
Kubena, Ales Antonin
Maly, Josef
Sulkova, Sylvie Dusilova
Immunosuppressive therapy related adherence, beliefs and self-management in kidney transplant outpatients
title Immunosuppressive therapy related adherence, beliefs and self-management in kidney transplant outpatients
title_full Immunosuppressive therapy related adherence, beliefs and self-management in kidney transplant outpatients
title_fullStr Immunosuppressive therapy related adherence, beliefs and self-management in kidney transplant outpatients
title_full_unstemmed Immunosuppressive therapy related adherence, beliefs and self-management in kidney transplant outpatients
title_short Immunosuppressive therapy related adherence, beliefs and self-management in kidney transplant outpatients
title_sort immunosuppressive therapy related adherence, beliefs and self-management in kidney transplant outpatients
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287542/
https://www.ncbi.nlm.nih.gov/pubmed/30584284
http://dx.doi.org/10.2147/PPA.S184166
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