Medication understanding, non-adherence, and clinical outcomes among adult kidney transplant recipients

• Type of Material: Article
• Authors: Rachel Patzer, Emory University; Marina Serper, University of Pennsylvania; Peter P. Reese, University of Pennsylvania; Kamila Przytula, Northwestern University; Rachel Koval, Emory University; Daniela P. Ladner, Northwestern University; Josh M. Levitsky, Northwestern University; Michael M. Abecassis, Northwestern University; Michael S. Wolf, Northwestern University
• Language: English
• Date: 2016-10
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
• Final Published Version (URL): http://dx.doi.org/10.1111/ctr.12821
• Title of Journal or Parent Work: Clinical Transplantation
• ISSN: 0902-0063
• Volume: 30
• Issue: 10
• Start Page: 1294
• End Page: 1305
• Grant/Funding Information: This project was supported by Award Number T32DK077662 from the National Institute of Diabetes and Digestive and Kidney Diseases.
• Keywords: RENAL-TRANSPLANT; Life Sciences & Biomedicine; kidney transplantation; SELF-REPORT; cognition; Surgery; PREVALENCE; Transplantation; hospitalization; RISK-FACTORS; medication adherence; DRUG WARNING LABELS; literacy; IMMUNOSUPPRESSIVE MEDICATION; Science & Technology; THERAPY; HEALTH LITERACY; ADHERENCE; GRAFT FAILURE
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

We sought to evaluate the prevalence of medication understanding and non-adherence of entire drug regimens among kidney transplantation (KT) recipients and to examine associations of these exposures with clinical outcomes. Structured, in-person interviews were conducted with 99 adult KT recipients between 2011 and 2012 at two transplant centers in Chicago, IL; and Atlanta, GA. Nearly, one-quarter (24%) of participants had limited literacy as measured by the Rapid Estimate of Adult Literacy in Medicine test; patients took a mean of 10 (SD=4) medications and 32% had a medication change within the last month. On average, patients knew what 91% of their medications were for (self-report) and demonstrated proper dosing (via observed demonstration) for 83% of medications. Overall, 35% were non-adherent based on either self-report or tacrolimus level. In multivariable analyses, fewer months since transplant and limited literacy were associated with non-adherence (all P < .05). Patients with minority race, a higher number of medications, and mild cognitive impairment had significantly lower treatment knowledge scores. Non-white race and lower income were associated with higher rates of hospitalization within a year following the interview. The identification of factors that predispose KT recipients to medication misunderstanding, non-adherence, and hospitalization could help target appropriate self-care interventions.