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

Rachel E. Patzer*, Marina Serper, Peter P. Reese, Kamila Przytula, Rachel Koval, Daniela P. Ladner, Josh M. Levitsky, Michael M. Abecassis, Michael S. Wolf

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

89 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1294-1305
Number of pages12
JournalClinical Transplantation
Volume30
Issue number10
DOIs
StatePublished - Oct 1 2016

Funding

We would like to acknowledge Ruth M. Parker, MD, Tess Gallegos, Michelle Miller, Brendan Lovasik, MD, Titilayo Ilori, MD, Audra Williams, MD, Paul Jurgens, Lisa T. Belter, Jennifer P. King, MPH, and John Friedewald, MD, for their assistance with this project. This project was supported by Award Number T32DK077662 from the National Institute of Diabetes and Digestive and Kidney Diseases. R.E. Patzer and M.S. Wolf are supported in part by R21NR014544.

Keywords

  • cognition
  • hospitalization
  • kidney transplantation
  • literacy
  • medication adherence

ASJC Scopus subject areas

  • Transplantation

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