Recruiting a representative sample in adherence research—The <scp>MALT</scp> multisite prospective cohort study experience

Shemesh, Eyal; Mitchell, Jeffrey; Neighbors, Katie; Feist, Susan; Hawkins, Andre; Brown, A. G. P.; Wanrong, Yin; Anand, Ravinder; Stuber, Margaret L.; Annunziato, Rachel A.

doi:10.1111/petr.13067

Cited by 19 publications

(13 citation statements)

References 26 publications

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“…On the level of patients, it is assumed that selection bias has occurred due to the large proportion of adherent patients, the small variety in ethnic background, the high percentage of patients who had a high level of education, and a long disease duration. In adherence research, the difficulty of recruiting patients who represent the general population is well recognized and often challenging (37,38).…”

Section: Discussionmentioning

confidence: 99%

Are Health Care Professionals’ Implicit and Explicit Attitudes Toward Conventional Disease‐Modifying Antirheumatic Drugs Associated With Those of Their Patients?

Heuckelum

Hebing

Vandeberg

et al. 2021

Arthritis Care & Research

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Objective It is generally unknown how the attitudes and beliefs of health care professionals (HCPs) might affect the attitudes, beliefs, and medication‐taking behavior of patients with rheumatoid arthritis (RA). This study aims 1) to examine the attitudes, health‐related associations (both implicit and explicit), and beliefs of HCPs about conventional disease‐modifying antirheumatic drugs, and 2) to assess whether these attitudes, health‐related associations, and beliefs of HCPs are associated with those of their patients, with their patients’ medication‐taking behavior, and disease activity. Methods HCPs were recruited from 2 centers that specialized in rheumatology across The Netherlands, and patient recruitment followed. In this observational study, implicit outcomes were measured with single‐category implicit association tests, whereas explicit outcomes were measured with a bipolar evaluative adjective scale and the Beliefs About Medicines Questionnaire–Specific. Spearman’s rank correlations were used to describe correlations between implicit and explicit measures of the attitudes of HCPs. Multilevel, mixed‐effects linear models were used to examine the association of HCP‐related characteristics, including the implicit and explicit outcomes of HCPs, with those of their patients, their medication‐taking behaviors, and disease activity. Results Of the 1,659 initially invited patients, 254 patients with RA (mean age 62.8 years, mean disease duration 11.8 years, and 68.1% of the patients were female) who were treated by 26 different HCPs agreed to participate in this study. The characteristics, attitudes, health‐related associations, and beliefs about medicines of HCPs were not significantly associated with those of their patients, nor with their medication‐taking behaviors or disease activity scores. Conclusion This study demonstrated that the attitudes, health‐related associations (as measured both implicitly and explicitly), and beliefs of HCPs were not significantly associated with the attitudes, beliefs, medication‐taking behavior, and disease activity of patients with RA.

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Section: Discussionmentioning

confidence: 99%

Are Health Care Professionals’ Implicit and Explicit Attitudes Toward Conventional Disease‐Modifying Antirheumatic Drugs Associated With Those of Their Patients?

Heuckelum

Hebing

Vandeberg

et al. 2021

Arthritis Care & Research

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“…Two notable exceptions were identified in which multiple transplant centers collaborated to recruit increasingly generalizable samples of recipients. Shemesh et al conducted a multisite study of 400 pediatric liver transplant recipients, or MALT, focusing on MLVI (medication level variability index, or SD scores from blood levels) and the prediction of transplant and medical outcomes. Danziger‐Isakov et al reported on adherence barriers collected from 386 patients across 15 transplant centers (CTOT‐C).…”

Section: Discussionmentioning

confidence: 99%

“…Shemesh et al23,26,80,81 conducted a multisite study of 400 pediatric liver transplant recipients, or MALT, focusing on MLVI (medication level variability index, or SD scores from blood levels) and the prediction of transplant and medical outcomes. Danziger-Isakov et al22 reported on adherence barriers collected from 386 patients across 15 transplant centers (CTOT-C).Small sample sizes and limited statistical power restricted statistical analytic options and opportunities as well as the ability to detect important predictors.…”

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confidence: 99%

Psychosocial predictors of medication non‐adherence in pediatric organ transplantation: A systematic review

Killian

Schuman

Mayersohn

et al. 2018

Pediatric Transplantation

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Adherence to immunosuppressant medication is critical to health and quality-of-life outcomes for children who have received a solid organ transplant. Research on the psychological and social predictors of medication adherence is essential to the advancement of pretransplant assessments and transplant psychosocial services. Despite the importance of identifying risk factors, the literature remains limited regarding psychosocial predictors of non-adherence. A systematic search was conducted to identify studies of the psychosocial predictors of post-transplant medication non-adherence in pediatric solid organ transplantation. From 1363 studies identified in searches of empirical literature, a final sample consisted of 54 publications representing 49 unique studies. Findings regarding psychosocial predictors were inconsistent with non-adherence associated largely with adolescence, racial/ethnic minority status, and presence of mental health issues. Familial predictors of non-adherence problems included single-parent households, lower socioeconomic status, lower family cohesion, presence of family conflict, and poor family communication. Several studies reported an association between non-adherence and social pressures (eg, peer social interaction, wanting to feel normal) among adolescent transplant recipients. While significant methodological and substantive gaps remain in this body of knowledge, this review synthesizes current evidence for assessment for transplant clinicians and researchers.

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“…While some enrolled patients were participating in other CTOTC studies with multiple visits and serial monitoring, enrollment in this study was extended to any recent transplant recipient at a participating center and was not contingent on participation in a more intensive study protocol. Selection bias might be present, but it is less likely than most other adherence studies with the high rate of completion of both study visits (92/123 enrollees, 75%) and the minimization of participant burden consistent with recommendations for avoiding selection bias in the transplant populations . Further, we acknowledge the distribution of transplant type in this study, which includes a substantial proportion of lung transplant recipients, is different than the general population of pediatric organ transplant recipients which is largely renal.…”

Section: Discussionmentioning

confidence: 80%

Perceived barriers to medication adherence remain stable following solid organ transplantation

Danziger‐Isakov

Frazier

Worley

et al. 2019

Pediatric Transplantation

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Perceived barriers to adherence have previously been investigated in SOT to identify plausible intervention targets to improve adherence and transplant outcomes. Fifteen centers in CTOTC enrolled patients longitudinally. Patients >8 years completed Adolescent Scale(AMBS) at two visits at least 6 months apart in the first 17 months post‐transplant while their guardians completed PMBS. Differences over time for pre‐identified AMBS/PMBS factors were analyzed. Perceived barrier reporting impact on subsequent TAC levels was assessed. A total of 123 patients or their guardians completed PMBS or AMBS. Twenty‐six were 6‐11 years and 97 were ≥12. The final cohort consisted of kidney (66%), lung (19%), liver (8%), and heart (7%) recipients. Unadjusted analysis showed no statistically significant change in reported barriers from visit 1 (median 2.6 months, range 1.2‐3.7 post‐transplant) to visit 2 (median 12, range 8.9‐16.5). Of 102 patients with TAC levels, 74 had a single level reported at both visits. The factor of “Disease frustration” was identified through the PMBS/AMBS questions about fatigue around medication and disease. Each point increase in “disease frustration” at visit 1 on the AMBS/PMBS doubled the odds of a lower‐than‐threshold TAC level at visit 2. No clear change in overall level of perceived barriers to medication adherence in the first year post‐transplant was seen in pediatric SOT. However, disease frustration early post‐transplant was associated with a single subtherapeutic TAC levels at 12 months. A brief screening measure may allow for early self‐identification of risk.

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Recruiting a representative sample in adherence research—The MALT multisite prospective cohort study experience

Cited by 19 publications

References 26 publications

Are Health Care Professionals’ Implicit and Explicit Attitudes Toward Conventional Disease‐Modifying Antirheumatic Drugs Associated With Those of Their Patients?

Are Health Care Professionals’ Implicit and Explicit Attitudes Toward Conventional Disease‐Modifying Antirheumatic Drugs Associated With Those of Their Patients?

Psychosocial predictors of medication non‐adherence in pediatric organ transplantation: A systematic review

Perceived barriers to medication adherence remain stable following solid organ transplantation

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