Time‐in‐a‐bottle (TIAB): a longitudinal, correlational study of patterns, potential predictors, and outcomes of immunosuppressive medication adherence in adult kidney transplant recipients

Abstract

This study examined patterns, potential predictors, and outcomes of immunosuppressive medication adherence in a convenience sample of 121 kidney transplant recipients aged 21 years or older from three kidney transplant centers using a theory-based, descriptive, correlational, longitudinal design. Electronic monitoring was conducted for 12 months using the Medication Event Monitoring System. Participants were persistent in taking their immunosuppressive medications, but execution, which includes both taking and timing, was poor. Older age was the only demographic variable associated with medication adherence (r = 0.25; p = 0.005). Of the potential predictors examined, only medication self-efficacy was associated with medication non-adherence, explaining about 9% of the variance (r = 0.31, p = 0.0006). The few poor outcomes that occurred were not significantly associated with medication non-adherence, although the small number of poor outcomes may have limited our ability to detect a link. Future research should test fully powered, theory-based, experimental interventions that include a medication self-efficacy component.

Providers' assessment of transition readiness among adolescent and young adult kidney transplant recipients

“…By demonstrating knowledge and skill attainment, AYAs are exhibiting behaviors showing providers that they are more ready to manage their health care and transfer to adult care. Medication adherence was not associated with provider's perception of transition readiness, which may be indicative of adherence being a challenge across the life course for transplant recipients and not necessarily a practical requirement for transition .…”

Adherence in Adolescent and Young Adult Kidney Transplant Recipients

“…in glomerular filtration rate, or graft loss [22]. However, poor outcomes were extremely uncommon in this cohort, suggesting that the study may have been underpowered to detect such associations.…”

“…It is unrealistic to expect that patients will always take their medications at exactly the same times every day. Most healthcare professionals are willing to accept a window of 1-2 hours around the expected dosing time [21,22]. It is important, however, that physicians, nurses and pharmacists discuss the intended dosing schedule with transplant recipients and agree upon set dosing times.…”

“…Micro-level factors: Whereas social support has not been consistently identified as a significant determinant of adherence among adults [11,22], lack of parental supervision and support, poor parent-patient communication, and poor family functioning have been identified as barriers to adherence among children and adolescents [4,5,51]. Family efficacy, defined as the family's ability to accomplish tasks needed to function, was associated with fewer perceived barriers to adherence [53].…”

Systematic review of continuous self-improvement interventions

“…Medication adherence is an intermediate outcome; other outcomes influenced by medication adherence may be measured including biological, psychological, and social outcomes. For example, adherence outcomes for those with kidney transplant could include creatinine, acute and chronic rejection, kidney loss, and death [37] .…”