Session Time: 3:15pm-4:45pm
Presentation Time: 3:39pm-3:51pm
*Purpose: We aimed to identify care processes and structures that are independently associated with higher medication adherence among adolescent and young adult transplant recipients.
*Methods: We conducted a prospective, observational cohort study of 270 prevalent kidney, liver, and heart transplant recipients 14-25 y followed in 1 of 14 paediatric or 14 adult transplant programs across Canada. All patients were >3 months post-transplant and >2 months post-discharge. Patients were classified as adherent or non-adherent at baseline, 3mo and 6 mo based on the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS); adherent patients had missed no immunosuppressive doses in the prior 4 weeks. Transplant program directors and nurses at each program completed questionnaires regarding organization of care, composition of the team, and care processes/protocols. Program-level factors that varied substantially across programs were considered in the models as potential independent correlates of higher adherence. We used mixed models, with program as a random effect, accounting for clustering by program and for repeated adherence measures within patients, to identify independent correlates of adherence. Models were adjusted for non-modifiable patient-level factors that may act as confounders due to their association with adherence (age, sex, time since transplant, donor source, number of meds, primary caregiver [self vs. other], who prepares meds).
*Results: There were 66 kidney, 16 liver, and 17 heart recipients in paediatric programs, and 118 kidney, 42 liver and 11 heart recipients in adult programs. The median age was 20.3 y (IQR 17.2-23.2); median time since transplant 5 y (IQR 2.1-10.7); 119 (44%) were female. At baseline, 71.5% were adherent. Factors significantly independently associated with greater adherence were greater minimum prescribed frequency of routine blood work for those >3 y post-transplant, routine reminders for blood work and greater average time spent with nurse (Table 1). Male sex (0.52 [0.36,0.75]) and longer time since transplant (0.95 [0.92,0.99]) were associated with significantly poorer adherence. Living donor source was associated with significantly better adherence (2.24 [1.51,3.33]).
*Conclusions: Program-level factors related to the ‘culture of care, including intensity of routine follow-up and support to patients, are associated with medication adherence. This suggests that interventions at the program level may support better adherence.
|Format||OR [95% CI] for good adherence|
|Minimum prescribed frequency of routine blood work (per 1 additional per y)||1.08 (1.02,1.14)|
|Routine reminders for blood work||1.53 (1.01,2.32)|
|Same nurse at each visit||1.15 (0.71,1.88)|
|Average time spent with nurse (per 5 min)||1.12 (1.04,1.21)|
|Pharmacist on care team||1.83 (0.69,4.83)|
|Self-management interventions offered||1.18 (0.73,0.92)|
To cite this abstract in AMA style:Dabirzadeh A, Foster B, Dahhou M, Mital S. Care Processes and Structures Associated with Higher Medication Adherence: The Positive Adherence Study [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/care-processes-and-structures-associated-with-higher-medication-adherence-the-positive-adherence-study/. Accessed March 6, 2021.
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