OBJECTIVE: The study objective was to determine the prevalence and risk factors for medication non-nadherence and misunderstanding among solid organ transplant (SOT) recipients; and examine their associations with clinical outcomes.
METHODS: A cross-sectional study was conducted with 192 participants (KT=98, LT=85, 9 combined) at 2 transplant centers from January to November 2012.In-person interviews assessed demographics, health literacy (Rapid Estimate of Adult Literacy in Medicine), cognitive function, social support, medication adherence (self report, tacrolimus levels), and actual medication understanding using a pill dosing tray. Clinical outcomes were obtained from the medical record. Summary statistics, Chi-squared tests, and multivariate logistic regression were used in data analysis.
RESULTS:Table1 shows: Baseline Characteristics, Medication Non-Adherence, and Misunderstanding by Organ Type.
|Variable||Kidney (N=98)||Liver (N=85)|
|Age, mean (SD)||53±13||57±12|
|Months since transplant, median (range)||41 [1,243]||19 [1,282]|
|# Medications, mean (SD)||10.1±4.4||10.4±4.3|
|Limited Health Literacy||23%||16%|
|Non-adherence (self report)||19%||28%|
|Inadequate Treatment Knowledge†||11%||27%|
Patients within 2 years post-transplant were less able to demonstrate adequate treatment knowledge (OR 5.2, 95% CI 1.9-15.4). In bivariate analysis, limited HL was associated with both inadequate treatment knowledge (chi2 6.4, p=0.01) and dosing misunderstanding (chi2 4.4 p=0.04). In multivariate analysis, LT (OR 2.6, CI 1.2-5.9) and non-White race (OR 3.2, CI 1.4-7.7) were associated with non-adherence by self-report, while limited HL predicted non-adherence by tacrolimus levels (OR 3.1,CI 1.1-8.9). Age ≥65 (OR 1.6,CI 1.1-2.3) transplant <2 years ago (OR 5.2, CI 1.8-15.4), LT (OR 3.3,CI 1.2-9.1), and higher number of medications (OR 1.2, CI 1.0-1.4) were associated with inadequate treatment knowledge (all p<.05 after adjusting for covariates).
CONCLUSIONS: SOT recipients with limited health literacy, older age, higher regimen complexity and within 2 years of transplant are at highest risk for medication-related problems. Interventions should aim to reduce non-adherence disparities in these patient attributes.
To cite this abstract in AMA style:Serper M, Patzer R, Przytula K, King J, Levitsky J, Ladner D, Koval R, Wolf M. Determinants of Medication Misunderstanding and Non-Adherence among Kidney and Liver Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/determinants-of-medication-misunderstanding-and-non-adherence-among-kidney-and-liver-transplant-recipients/. Accessed December 12, 2019.
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