Multi-level factors are associated with immunosuppressant nonadherence in heart transplant recipients: the international bright study
| Autor: | Denhaerynck, K., Berben, L., Dobbels, F., Russell, C. L., Crespo-Leiro, M. G., Poncelet, A. J., De Geest, S., Cupples, S., De Simone, P., Groenewoud, A., Kugler, C., Ohler, L., Van Cleemput, J., Sebbag, L., Michel, M., Bernard, A., Doesch, A., Livi, U., Manfredini, V., Brossa-Loidi, V., Segovia-Cubero, J., Almenar-Bonet, L., Saint-Gerons, C. S., Mohacsi, P., Horvath, E., Riotto, C., Parry, G., Firouzi, A., Kozuszko, S., Haddad, H., Kaan, A., Fisher, G., Miller, T., Flattery, M., Ludrosky, K., Coleman, B., Trammell, J., t. Clair K., S, Kao, A., Molina, M., Canales, K. R., de Almeida, S. S., Ayoub, A. C., Barone, F., Harkess, M., Maddicks-Law, J. |
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| Přispěvatelé: | UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Psychological intervention immunosuppression/immune modulation 030230 surgery Research initiative Logistic regression clinical research/practice Dose-Response Relationship 03 medical and health sciences 0302 clinical medicine Immunology and Allergy Medicine Humans Pharmacology (medical) 030212 general & internal medicine heart transplantation/cardiology Heart transplantation clinical decision-making Transplantation Dose-Response Relationship Drug business.industry Odds ratio Middle Aged compliance/adherence social sciences Cross-Sectional Studies Female Immunosuppressive Agents Heart Transplantation Patient Compliance Family medicine Drug business Organization level Healthcare providers |
| Zdroj: | American Journal of Transplantation, Vol. 8, no. 6, p. 1447-1460 (2018) |
| Popis: | Factors at the level of family/healthcare worker-, organization- and system are neglected in medication nonadherence research in heart transplantation (HTx). The four-continent, eleven-country cross-sectional BRIGHT study used multi-staged sampling to examine 36 HTx centers, including 36 HTx directors, 100 clinicians, and 1397 patients. Nonadherence to immunosuppressants-defined as any deviation in taking or timing adherence and/or dose reduction-was assessed using the BAASIS® interview. Guided by the Integrative Model of Behavioral Prediction and Bronfenbrenner's ecological model, we analyzed factors at these multiple levels using sequential logistic regression analysis (6 blocks). The nonadherence prevalence was 34.1%. Six multi-level factors were associated independently (either positively or negatively) with nonadherence: patient level: barriers to taking immunosuppressants (OR: 11.48); smoking (OR:2.19); family/healthcare provider level: frequency of having someone to help patients read health-related materials (OR:0.85); organization level: clinicians reporting non-adherent patients were targeted with adherence interventions (OR: 0.66); pick-up of medications at physician's office (OR: 2.31); and policy level: monthly out-of-pocket costs for medication (OR: 1.16). Factors associated with nonadherence are evident at multiple levels. Improving medication nonadherence requires addressing not only the patient, but also family/healthcare provider, organization, and policy levels. This article is protected by copyright. All rights reserved. ispartof: American Journal of Transplantation vol:18 issue:6 pages:1447-1460 ispartof: location:United States status: published |
| Databáze: | OpenAIRE |
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