Patient involvement in selection of immunosuppressive regimen following transplantation

Figures & data

Table 1 Barriers, causes, and calls to action to improve adherence

Potential adherence barriers	Potential causes of adherence barriers	Calls to action to overcome adherence barriers
Medical	Side effects Drug interactions Pill burden	Involvement of pharmaceutical companies in modification of current medications and development of new ones to reduce side effects and interactions Involvement of pharmacists and specialist nurses as well as physicians to identify patients with side effects and potential drug interactions Careful monitoring of drug levels to avoid toxic side effects or problems due to inadequate dosing Dietitian involvement to ensure appropriate medication delivery and to ensure a healthy diet with only necessary restrictions Regular review of entire patient prescriptions to rationalize pill burden Ongoing liaison with community doctors and pharmacists
Social	Peer pressure Restriction by work, social life Disruption of routines, eg, job loss, moving house, divorce, transitioning to new units or from pediatric to adult units	Create awareness of transplantation and immunosuppression adherence in society through educational sessions, social media, and television Development of buddy programs to convert peer pressure to positive support Develop supportive pathways for seamless transition of young adults from pediatric to adult services Social worker involvement Psychology services
Emotional and mental	Depression Mood swings Psychosis	Early identification of symptoms in patients Identification and involvement of patient’s network (next of kin, family, friends) where appropriate Integrated support from psychologists and/or psychiatrists depending on diagnosis
Educational	Illiteracy Complex regimens	Development of clear educational strategies to suit the patient’s educational level Early recognition of patients who may struggle, ideally in the pre-transplant period Use of dosette boxes, blister packs, direct observation, alarms, and drug cards Simplification of the immunosuppressant regimens, eg, use of once daily regimens Tailoring regimens to suit patient’s lifestyle
Financial	Cost of immunosuppressant medications	Call to pharmaceutical companies to rationalize prices with potential discounts for developing countries Use of properly tested generics to create a competitive market Government legislation to ensure support for immunosuppressant regimen cost for patients without adequate insurance, subsidizing or covering cost for the life of the transplant Create awareness in patients about prioritization of their immunosuppressants in situations of limited finances Input from social workers

Note: The information in this table is not exhaustive but rather seeks to compartmentalize some of the potential barriers to adherence and offer potential solutions.