Medication, Healthcare Follow-up, and Lifestyle Nonadherence: Do They Share the Same Risk Factors?

Abstract

Background. Barriers to medication adherence may differ from barriers in other domains of adherence. In this study, we assessed the association between pre–kidney transplantation (KT) factors with nonadherent behaviors in 3 different domains post-KT. Methods. We conducted a prospective cohort study with patient interviews at initial KT evaluation (baseline—nonadherence predictors in sociodemographic, condition-related, health system, and patient-related psychosocial factors) and at ≈6 mo post-KT (adherence outcomes: medications, healthcare follow-up, and lifestyle behavior). All patients who underwent KT at our institution and had ≈6-mo follow-up interview were included in the study. We assessed nonadherence in 3 different domains using continuous composite measures derived from the Health Habit Survey. We built multiple linear and logistic regression models, adjusting for baseline characteristics, to predict adherence outcomes. Results. We included 173 participants. Black race (mean difference in adherence score: −0.72; 95% confidence interval [CI], −1.12 to −0.32) and higher income (mean difference: −0.34; 95% CI, −0.67 to −0.02) predicted lower medication adherence. Experience of racial discrimination predicted lower adherence (odds ratio, 0.31; 95% CI, 0.12–0.76) and having internal locus of control predicted better adherence (odds ratio, 1.46; 95% CI, 1.06–2.03) to healthcare follow-up. In the lifestyle domain, higher education (mean difference: 0.75; 95% CI, 0.21–1.29) and lower body mass index (mean difference: −0.08; 95% CI, −0.13 to −0.03) predicted better adherence to dietary recommendations, but no risk factors predicted exercise adherence. Conclusions. Different nonadherence behaviors may stem from different motivation and risk factors (eg, clinic nonattendance due to experiencing racial discrimination). Thus adherence intervention should be individualized to target at-risk population (eg, bias reduction training for medical staff to improve patient adherence to clinic visit).

Follow-Up Factors Contribute to Immunosuppressant Adherence in Kidney Transplant Recipients

“…Follow-up adherence was as high as another study in Chinese kidney transplantations by Zhao et al 16 Contrary to our hypothesis, no significant association was found between follow-up adherence and ISM adherence. This result may to some extent be in line with the study by Ng et al, 15 which suggested that the at-risk population for one domain of non-adherence may not be the same as those at risk for other non-adherence behaviors. Zhao et al’s study revealed that time after kidney transplantation was a factor affecting patient’s adherence to follow-up, the longer the time after transplantation, the poorer the adherence to follow-up.…”

“…With the exception of ISM non-adherence, kidney transplant patients are also reported to have follow-up non-adherence. 15 This may also lead to medication non-adherence in patients. Follow-up adherence plays a vital role in the medical surveillance of the kidney transplant recipients.…”

Kidney-transplanted Adolescents—Nonadherence and Graft Outcomes During the Transition Phase: A Nationwide Analysis, 2000–2020

“… 32 , 42 On the other hand, a recently published study found that LD transplant was not significantly associated with medication adherence, but rather with adherence to healthcare follow-ups, such as blood samples and clinical appointments. 43 We also recognize the fact that age itself is highly associated with risk for graft loss. 8 …”

Reliability and Validity of the Japanese Version of the Basel Assessment of Adherence to Immunosuppressive Medications Scale in Kidney Transplant Recipients

“…Studies conducted in Juiz de Fora, Brazil, and Pittsburgh, United States, reported that higher income was associated with MNA, whereas a study conducted in New York, United States, reported that lower income was associated with MNA. 33 , 47 , 48 In the United States, 70% of KTRs reported serious problems with paying for their medications, and 68% of KTRs reported deaths or graft losses as a result of cost-related MNA. 49 By contrast, in Japan, patients have free access to any healthcare provider, from small clinics to large hospitals with the latest facilities, and the self-pay burden of KTRs is minimized to only 0 to 20 000 yen according to income level by the country’s Medical Payment for Services and Supports for Persons with Disabilities.…”