Nonadherence Consensus Conference Summary Report

Abstract

This report is a summary of a 'Consensus Conference' on nonadherence (NA) to immunosuppressants. Its aims were: (1) to discuss the state-of-the-art on the definition, prevalence and measurement of NA, its risk factors and impact on clinical and economical outcomes and interventions and (2) to provide recommendations for future studies. A two-day meeting was held in Florida in January 2008, inviting 66 medical and allied health adherence transplant and nontransplant experts. A scientific committee prepared the meeting. Consensus was reached using plenary and interactive presentations and discussions in small breakout groups. Plenary presenters prepared a summary beforehand. Break-out group leaders initiated discussion between the group members prior to the meeting using conference calls and e-mail and provided a summary afterward. Conclusions were that NA: (a) is more prevalent than we assume; (b) is hard to measure accurately; (c) tends to confer worse outcomes; (d) happens for a number of reasons, and system-related factors including the patient's culture, the healthcare provider and the setting and (e) it is not currently known how to improve adherence. This consensus report provided some roadmaps for future studies on this complicated, multifaceted problem.

A New Taxonomy for Describing and Defining Adherence to Medications

“…Operational definitions for the implementation of a dosing regimen should be drug-and disease-specific.Clinically relevant definitions need to be developed, indicating which deviation from the prescribed medication regimen is sufficient to influence adversely the regimen's intended effect [133][134][135]. Further discussions on operational definitions are beyond our scope and have to do with the intricacies of time series analyses.…”

Stress, coping and adherence to immunosuppressive medications in kidney transplantation: a comparative study

“…12 As previously mentioned, to evaluate adherence to immunosuppressive drugs, we applied BAASIS, [32][33][34] as validated for use in Portuguese. 31 BAASIS assesses relevant dimensions of immunosuppressive drug use (i.e.…”

“…Specific characteristics of the individual, like psychiatric disorders, stress and coping strategies, are included at the patient level. 10,11 On the other hand, nonadherence in the field of transplantation, defined as any deviation from the drug regimen prescribed that negatively affects the results, 12 represents risky behavior and is associated with reduced kidney allograft survival, lower quality of life and increased public spending. 5,6,13,14 Unfortunately, nonadherence to immunosuppressants is common among kidney transplantation patients and some reports have shown that kidney recipients are the most nonadherent among all transplantation patients.…”

The influence of depressive symptoms and substance use on adherence to antiretroviral therapy. A cross-sectional prevalence study

“…1,2 Conceptually, adherence is "the extent to which the patient's behavior matches the prescriber's agreed recommendations". 3 Among the multifactorial causes of non-adherence to antiretroviral therapy (ART), 4 it has been observed that substance use [5][6][7] and depressive symptoms 4,8 have an impact. Substance use disorders and mood disorders are the most common psychiatric diseases among HIV-positive patients, and have been shown to affect people living with HIV (PLWH) significantly more often than the general population.…”