Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study

Abstract

Factors at the level of family/healthcare worker, organization, and system are neglected in medication nonadherence research in heart transplantation (HTx). The 4‐continent, 11‐country cross‐sectional Building Research Initiative Group: Chronic Illness Management and Adherence in Transplantation (BRIGHT) study used multistaged sampling to examine 36 HTx centers, including 36 HTx directors, 100 clinicians, and 1397 patients. Nonadherence to immunosuppressants—defined as any deviation in taking or timing adherence and/or dose reduction—was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale© (BAASIS ©) interview. Guided by the Integrative Model of Behavioral Prediction and Bronfenbrenner's ecological model, we analyzed factors at these multiple levels using sequential logistic regression analysis (6 blocks). The nonadherence prevalence was 34.1%. Six multilevel factors were associated independently (either positively or negatively) with nonadherence: patient level: barriers to taking immunosuppressants (odds ratio [OR]: 11.48); smoking (OR: 2.19); family/healthcare provider level: frequency of having someone to help patients read health‐related materials (OR: 0.85); organization level: clinicians reporting nonadherent patients were targeted with adherence interventions (OR: 0.66); pickup of medications at physician's office (OR: 2.31); and policy level: monthly out‐of‐pocket costs for medication (OR: 1.16). Factors associated with nonadherence are evident at multiple levels. Improving medication nonadherence requires addressing not only the patient, but also family/healthcare provider, organization, and policy levels.

The international prevalence and variability of nonadherence to the nonpharmacologic treatment regimen after heart transplantation: Findings from the cross‐sectional BRIGHT study

“…This study used data from the Building Research Initiative Group: Chronic Illness Management and Adherence in Transplantation (BRIGHT) study (ClinicalTrials.gov ID: NCT01608477), a cross‐sectional study assessing healthcare providers’ practice patterns and the prevalence and variability of nonadherence to the post‐HTx treatment regimen in 36 HTx centers from 11 countries in Asia, Europe, North America, and South America.…”

“…HTx recipients were excluded if they had participated in adherence intervention research or drug trials during the 6 months prior to inclusion or if they had received professional support for medication intake. Detailed information on the methodology of the BRIGHT study is reported elsewhere …”

“…Detailed information on the methodology of the BRIGHT study is reported elsewhere. 10,11 The data were collected (once for each HTx recipient) between March 2012 and October 2015 after obtaining ethical approval from each participating center's institutional review board (IRB) or ethics committee.…”

Perceived barriers to medication adherence remain stable following solid organ transplantation

“…Additionally, our study only measured perceived barriers based on patient perception. Emerging evidence has ascertained that multilevel influences exist including barriers at the provider, organizational, and policy level . These were not addressed in the current study.…”

Developing a rare disease chronic care model: Management of systemic sclerosis (MANOSS) study protocol

“…Psychometric evidence: Original English version: 5 of the original 10 items retained in a unidimensional scale, with a Cronbach's alpha of 0.82 (Denhaerynck et al, ). German and French version: No further information available…”