https://orcid.org/0000-0001-8927-7310
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.
Ethics Statement
Ethical approval was obtained from the University Hospital Hradec Kralove (No. 201902 S21P). All patients signed a written consent to participate in the study and agreed with the dissemination of anonymized results.
Acknowledgments
The authors acknowledge the University Hospital Hradec Kralove for providing the clinical data for this research, the nurses (particularly Zuzana Sircekova and Alena Molnarova) at the Transplantation Clinic for their contribution in addressing patients to participate in the study, the Patients’ Organization Alzbeta for their help in developing and piloting the testing of the self-reported tools, and patients who participated in this study. The authors also acknowledge Professor Sabina M. De Geest from the University of Basel for granting permission to use the BAASIS© scale and Professor Rob Horne from the University College London for granting permission to use the MARS-5© and BMQ© scales.
Disclosure
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.