Noncompliance in Organ Transplant Recipients

Schweizer, Robert T.; Rovelli, M; Palmeri, Debera; Vossler, E; Hull, David; Bartus, Stanley A.

doi:10.1097/00007890-199002000-00029

Cited by 310 publications

(227 citation statements)

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“…Single-center studies find that noncompliance and subsequent graft survival are correlated with socioeconomic status (4,8). Sanders et al (3) report better graft survival among low-income recipients of free cyclosporine from Sandoz Pharmaceuticals (East Hanover, NJ) through the National Organization for Rare Disorders.…”

Section: Discussionmentioning

confidence: 99%

“…Following Sanders et al and Schweizer et al (3,4) we hypothesized that the cost of immunosuppressive medications would be more burdensome, and thus graft failure would be greater among low-income individuals. To determine whether the extension of Medicare's immunosuppressive coverage was associated with improved overall graft survival in highand low-income individuals, we merged clinical and United States Postal Service ZIP code data available in the United States Renal Data System (USRDS) database with income data by ZIP code from the United States Census.…”

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confidence: 99%

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Effect of Extended Coverage of Immunosuppressive Medications by Medicare on the Survival of Cadaveric Renal Transplants

Woodward

Schnitzler

Lowell

et al. 2001

American Journal of Transplantation

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Between 1993 and 1995, Medicare extended its coverage of maintenance immunosuppression medications following renal transplantation from 1 to 3 years. We hypothesized that Medicare's extension of immunosuppressive coverage would improve graft survival among low-income transplant recipients. We merged patient-level clinical data from the USRDS-distributed UNOS registry of kidney transplants throughout the USA with median family income for each patient's ZIP code from the 1990 Census. We were able to merge median incomes to 10 837 first cadaveric renal transplants performed in 1992-93 and 16 732 performed in 1995-97. Each of these chronological cohorts was divided into two groups, those with family incomes above (high-income group) and those below (low-income group) $36 033. There were no differences in graft survival at 1 year based on income in either chronological era. However, when Medicare covered immunosuppression medications for just 1 year, the low-income group of 1-year graft survivors had a 4.5% lower graft survival at the end of 3 years post-transplant (p ∞0.001). During the 1995-97 period, during which Medicare provided 3 years' immunosuppression coverage, the low-income and high-income groups had equivalent graft survival at 3 years post-transplant.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effect of Extended Coverage of Immunosuppressive Medications by Medicare on the Survival of Cadaveric Renal Transplants

Woodward

Schnitzler

Lowell

et al. 2001

American Journal of Transplantation

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“…Schweizer et al 6 found that for those who were noncompliant with medication regimens, 91% of kidney patients, 66% of liver patients, and 50% of heart patients, died or lost their graft. Fifty-seven percent of appointment noncompliant renal transplant patients experienced one or more late acute rejection episodes compared to 2% of compliant patients.…”

Section: Consequencesmentioning

confidence: 99%

“…Elderly patients and those under 20 appear to be at risk. 8 Low socioeconomic status may be a barrier 6 if a patient does not have resources for transportation to clinic appointments, or to cover medication costs. Absence of social and family support can be a significant contributor to noncompliance [16][17][18]22 and may explain why the presence of a caregiver was a prognostic indicator of survival following allogeneic SCT.…”

Section: Patient-related Factorsmentioning

confidence: 99%

Mismanaging the gift of life: noncompliance in the context of adult stem cell transplantation

Bishop

Rodrigue

Wingard

2002

Bone Marrow Transplant

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Summary:In this paper, we address the issue of noncompliance with medical regimens in adult stem cell transplant patients. We review the definition, prevalence, and consequences of noncompliance and address whether or not we should alter our medical decision-making with regard to stem cell transplantation based on patient noncompliance. We discuss how the health care team should handle noncompliance issues and propose clinical guidelines for stem cell transplant programs to consider regarding evaluation and management of medical compliance. Bone Marrow Transplantation (2002) 29, 875-880. DOI: 10.1038/sj/bmt/1703523 Keywords: compliance; adult; stem cell transplantation; medical decision-making; clinical guidelinesThe ultimate success of a medical therapy is dependent upon patients' ability and willingness to engage in and maintain certain health behaviors. Noncompliance with medical regimens can result in increased morbidity, mortality, unnecessary healthcare costs, and ultimately, loss of life. Given the advances of stem cell transplantation (SCT), now used successfully to treat a variety of once fatal diseases, very little attention has focused on factors that may maintain or maximize the life that is prolonged by this procedure. We are aware of no published studies that describe the compliance behaviors of adult SCT recipients. In this paper we review the definition, prevalence, and consequences of noncompliance and extrapolate from the general medical and solid organ transplantation (SOT) literatures, how these data could relate to post-SCT outcomes. We then pose two key questions. First, should we alter our medical decision-making based on patient noncompliance? Second, how should the health care team handle noncompliance issues? In conclusion, we propose clinical guidelines for SCT programs to consider regarding evaluation and management of medical compliance. Overview of noncompliance DefinitionThe most quoted definition of compliance is probably that of Haynes et al: 1 'the extent to which a person's behavior (in terms of medication, following diets, or executing lifestyle changes) coincides with medical or health advice'. This useful definition encompasses both the range of possible patient behaviors, as well as the degree to which a patient is compliant. Medical regimens include a variety of behaviors, such as taking medication, attending clinical appointments, following exercise and diet plans, abstaining from or limiting substance use, and engaging in preventive health behaviors. Thus, 'noncompliance is the degree to which behavior fails to coincide with medical recommendations in each of these areas'. 2 Compliance can be complete or partial, erratic or patterned. 3 Noncompliance is usually inadvertent, but can be intentional. Because of the range and number of health behaviors asked of patients, in most cases a patient cannot be described globally as noncompliant. Thus, health professionals should distinguish between compliers, partial compliers, and noncompliers, and not assume that patients who a...

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“…A majority of the population with health insurance coverage in the United States obtains it through their employment [29]. There is evidence to suggest that lack of insurance can significantly contribute toward non-compliance and might be responsible for up to 35% of renal allograft loss [28,[30][31][32].…”

Section: Known Disparities In Access To Renal Transplantmentioning

confidence: 99%

Socioeconomic Factors in Access to Renal Transplantation

Gurprataap¹,

Hu²,

Dhakarwal³

2017

J Nephrol Ther

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Background: Traditional socio-economic status (SES) factors that have been associated with access to renal transplantation include race, gender and income. However, these traditional factors are neither specific nor sensitive for 'at risk' status. There are now new and comprehensive SES assessment tools like the Social adaptability index (SAI) that provide an accurate and reliable estimate of an individual's social adaptability, and have been shown to predict graft failure and access to renal transplantation.

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Noncompliance in Organ Transplant Recipients

Cited by 310 publications

References 0 publications

Effect of Extended Coverage of Immunosuppressive Medications by Medicare on the Survival of Cadaveric Renal Transplants

Effect of Extended Coverage of Immunosuppressive Medications by Medicare on the Survival of Cadaveric Renal Transplants

Mismanaging the gift of life: noncompliance in the context of adult stem cell transplantation

Socioeconomic Factors in Access to Renal Transplantation

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