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. 2021 Dec 31:15:2877-2887.
doi: 10.2147/PPA.S344878. eCollection 2021.

Changes in Beliefs About Post-Transplant Immunosuppressants Over Time and Its Relation to Medication Adherence and Kidney Graft Dysfunction: A Follow-Up Study

Barbora Kostalova  1 , Katerina Mala-Ladova  1 , Ales Antonin Kubena  1 , Rob Horne  2 , Sylvie Dusilova Sulkova  3 , Josef Maly  1
Affiliations

Changes in Beliefs About Post-Transplant Immunosuppressants Over Time and Its Relation to Medication Adherence and Kidney Graft Dysfunction: A Follow-Up Study

Barbora Kostalova et al. Patient Prefer Adherence. .

Abstract

Purpose: The main aim was to evaluate the changes in beliefs about immunosuppressants over a 3-year period in patients after kidney transplantation. The second aim was to investigate the relationship between beliefs, medication adherence, and selected clinical outcomes such as graft functioning.

Patients and methods: This observational follow-up study was conducted in the outpatient post-transplant clinic at the University Hospital Hradec Kralove in the Czech Republic. Adult patients, at least 4 weeks after kidney transplantation, were invited for the structured interview, which was followed by a self-administered questionnaire survey during their regularly scheduled visits at the clinic. Appropriate paired tests were used to compare two measurements of beliefs about immunosuppressants by BMQ-CZ© in 2016 (baseline) and in 2019 (follow-up). Self-reported adherence was measured by two validated tools (MARS-CZ© and BAASIS©) capturing implementation and discontinuation phases. A generalized linear model was used to investigate the relation between beliefs and the consecutive estimated glomerular filtration rate.

Results: The study involved 134 patients. Over time, their perceived treatment necessity beliefs of immunosuppressants decreased, while their treatment-related concerns increased. Overall self-reported non-adherence (ie, taking, dosing and discontinuation of immunosuppressants) was reported by 12% of the patients in both observation periods. In the follow-up period, timing non-adherence was reported by 52 (38.8%) patients. Higher baseline treatment concerns were associated with poor adherence whereas higher baseline treatment necessity beliefs corresponded with better kidney functioning, even after adjusting for age.

Conclusion: Higher treatment necessity beliefs corresponded with better kidney functioning, whereas higher treatment concerns were related to non-adherence to immunosuppressants at the beginning of the observed period. Still, most patients accepted their medicines that do not come without risk. Nevertheless, decreasing treatment necessity beliefs on one hand, and increasing treatment concerns on the other, should be considered in clinical practice.

Keywords: immunosuppressants; kidney transplantation; medication adherence; treatment concerns; treatment necessity beliefs.

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Conflict of interest statement

Professor Rob Horne is supported by the National Institute for Health Research (NIHR, Collaboration for Leadership in Applied Health Research and Care (CLAHRC), North Thames at Bart’s Health NHS Trust and Asthma UK (AUKCAR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health; also reports personal fees from Speaker engagements with honoraria with the following companies: AbbVie, Abbott, Amgen, Astellas, AstraZeneca, Boehringer Ingelheim, Biogen, Gilead Sciences, GlaxoSmithKline, Janssen, Merck Sharp Dohme, Merck, Novartis, Pfizer, Procter & Gamble, Roche, Sanofi, Shire Pharmaceuticals, TEVA, UCB. In addition, Professor Rob Horne is Founding Director of UCL-Business company (Spoonful of Sugar Ltd) providing consultancy on treatment engagement and patient support programmes to healthcare policy makers, providers and pharmaceutical industry outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Study population.
Figure 2
Figure 2
Boxplots showing the Necessity–Concerns Differential (NCD) scores during Phase I and II (n=134).
Figure 3
Figure 3
Evolution of treatment necessity and concerns beliefs during Phase I and II (n=134).
See this image and copyright information in PMC

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