Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
ID
4495075
Author(s)
Denhaerynck, Kris; Berben, Lut; Dobbels, Fabienne; Russell, Cynthia L.; Crespo-Leiro, Marisa G.; Poncelet, Alain Jean; De Geest, Sabina
Author(s) at UniBasel
De Geest, Sabina M. Denhaerynck, Kris
Year
2018
Title
Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study
Journal
American journal of transplantation
Volume
18
Number
6
Pages / Article-Number
1447-1460
Mesh terms
Adult; Cross-Sectional Studies; Dose-Response Relationship, Drug; Female; Heart Transplantation; Humans; Immunosuppressive Agents, therapeutic use; Male; Middle Aged; Patient Compliance
Abstract
Factors at the level of family/healthcare worker, organization, and system are neglected in medication nonadherence research in heart transplantation (HTx). The 4-continent, 11-country cross-sectional Building Research Initiative Group: Chronic Illness Management and Adherence in Transplantation (BRIGHT) study used multistaged sampling to examine 36 HTx centers, including 36 HTx directors, 100 clinicians, and 1397 patients. Nonadherence to immunosuppressants-defined as any deviation in taking or timing adherence and/or dose reduction-was assessed using the Basel Assessment of Adherence to Immunosuppressive Medications Scale; ©; (BAASIS; ©; ) interview. Guided by the Integrative Model of Behavioral Prediction and Bronfenbrenner's ecological model, we analyzed factors at these multiple levels using sequential logistic regression analysis (6 blocks). The nonadherence prevalence was 34.1%. Six multilevel factors were associated independently (either positively or negatively) with nonadherence: patient level: barriers to taking immunosuppressants (odds ratio [OR]: 11.48); smoking (OR: 2.19); family/healthcare provider level: frequency of having someone to help patients read health-related materials (OR: 0.85); organization level: clinicians reporting nonadherent patients were targeted with adherence interventions (OR: 0.66); pickup of medications at physician's office (OR: 2.31); and policy level: monthly out-of-pocket costs for medication (OR: 1.16). Factors associated with nonadherence are evident at multiple levels. Improving medication nonadherence requires addressing not only the patient, but also family/healthcare provider, organization, and policy levels.
Publisher
WILEY
ISSN/ISBN
1600-6135
edoc-URL
https://edoc.unibas.ch/68491/
Full Text on edoc
No
Digital Object Identifier DOI
10.1111/ajt.14611
PubMed ID
http://www.ncbi.nlm.nih.gov/pubmed/29205855
ISI-Number
WOS:000434051200020
Document type (ISI)
Journal Article
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