Evaluate to the Efficacy and Effectiveness of Different Assessment Methods on Medication Adherence in Kidney Transplant Recipients

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Abstract

Introduction

Medication non-adherence has been recognized as a great challenge in transplant center worldwide. Non-adherence to an immunosuppressive regimen has been reported to be associated with graft function loss and patient mortality. Medication adherence can be monitored directly through blood or urine drug assays, use of drug markers with the target medication, and observation of the patient ingesting the medication, or indirectly through patient self report, electronic monitoring device use, and prescription.

Aim

The aim of the study is examine efficacy and effectiveness of different assessment measurement methods and different self reported scales on medical adherence in kidney transplant recipient.

Materials and Method

This is cross-sectional and descriptive study was performed on 147 kidney transplant recipients. This study was conducting between April-November 2017. Data were collecting using Immunosuppressant therapy adherence scale-ITAS, Immunosuppressive Medication Adherence Scale (IMAS), biological assay assessment. For biological assay, last five tacrolimus blood plasma levels were evaluated and Standard Deviation (SD) was calculated for each patient. Medication non-adherence as SD cutt-off point was taken >2.58. Data were analyzed using SPSS software. Descriptive statistical analysis (mean, standard deviation, ratio). Written consent was obtained from all participants prior to data collection. Approval was given by the hospital and Ethics Committees.

Results

The mean age of the participants was 45.00±12.60 (min-max = 19-77y). Of the patients, 58.5% (n = 86) were male, 50.3% (n=74) were 10 year above after transplantation. It is determined 76 patients of 147 patients were used tacrolimus based immunosuppressive therapy. Tacrolimus levels of three patients were not reliable. Medication adherence SD level of 63% (n=59) was found under 2.58 and 22.37% (n= 15) of them was found elevated 2.58. ITAS mean is found 11.17±1.22 (min-max=4-12). In patients who only tacrolimus based therapy used, the mean total score obtained from the ITAS was 11.02±1.27 and 43, 18, 11 patients had taken full point, 11 and 10 point respectively. IMAS mean was found 43.42±3.46 (min-max=35-53). In patients who only tacrolimus based therapy used, the mean obtained from IMAS was 43.96±3.85.

Conclusion

We found that especially patient gave more higher in ITAS self reported assessment. Patient self-report is inadequate because patients tend to tell health care providers what they think the provider wants to hear. Also, the biological assay method may need careful interpretation, however, due to variations in pharmacokinetics. Electronic monitoring can be help to record pill-bottle cap opening data and time to reveal patients’ medication use. Thus, it has been suggested as a reference standard that assures the validity of adherence measurement. We advise to use electronic monitoring for assess to medication adherence of the patients.

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