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

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.

Keywords: cognition; hospitalization; kidney transplantation; literacy; medication adherence.

FIGURE 1

Conceptual framework for medication self-management. Medication self-management for transplant recipients is a multistep process by which organ transplant recipients take their medication. The patient must first fill the prescription, and then, the patient should be able to correctly name, identify, and understand the medication. The third step is organization of multiple medications into the appropriate dosing frequency. Next, actually taking the medication at the correct dosage is essential. For those who are on complex or multiple medications, monitoring medication changes is essential. Finally, patients must sustain medication behaviors indefinitely to achieve medication self-management