Summary
Psychosocial aspects of medication nonadherence after kidney transplantation
Mirjam Tielen
AIM: Patients have to take immunosuppressive medication after kidney transplantation to prevent rejection of the graft. This thesis investigated patients’ adherence behaviour and attitudes and beliefs about the immunosuppressive regime.
METHOD: The study was performed in a teaching hospital in The Netherlands. Data were collected on young adults (18-25yrs), the elderly (>65 yrs) and a kidney transplantation cohort of all ages. Two cross-sectional studies and one prospective study were performed. In the prospective study, we used different questionnaires and self-reported nonadherence at different time points, namely 6 weeks before plus 6 and 18 months after kidney transplantation.
FINDINGS: Three distinct attitude profiles concerning post-transplant health lifestyle were repeatedly found: (i) patients who were afraid of rejection and therefore took their medication, (ii) patients who felt secure and knew they could take good care of this kidney, and (iii) patients who found their appearance important and experienced medication side-effects. The profiles were not correlated with nonadherence. Patients found themselves capable of taking the medication correctly and understood the importance; nevertheless 6 weeks after kidney transplantation, 17% were classified as nonadherent with a significant lower graft survival. The rate of nonadherence increased to 31% at 18 months. Younger patients who had unrealistic beliefs about the graft survival had a higher risk of nonadherence. Patients who reported low importance of medication adherence as a personal goal were more likely to become nonadherent over time.
DISCUSSION and CONCLUSION: The selfreported nonadherence levels found in this study so soon after transplantation demonstrate the need for early and continued intervention after kidney transplantation in order to maximize adherence and consequently clinical outcomes. Changes in (unrealistic) beliefs regarding the longevity of the graft may offer a potential target for intervention among nonadherent patients.
