Immunosuppressive medication adherence and affecting factors in solid organ transplantation patients: a mixed-methods study

Abstract

Objectives: Transplantation is a form of treatment that requires long-term pharmacotherapy. After transplantation, patients may have difficulty adapting to medication use for various reasons, and this may result in rejection. The aim of this study is to determine participants’ medication compliance and the factors affecting it.

Methods: The research was conducted with a sequential explanatory mixed method. In the study, quantitative data were collected using the Turkish Immunosuppressive Medication Adherence Scale, and qualitative data were collected using the In-Depth Individual Interview Guide. Quantitative data were analyzed using statistical methods, and qualitative data were examined according to Braun and Clarke's thematic analysis framework.

Results: In this study, 62.3% of the participants were male, 37.0% were 50 years old and over, 71.3% lived with their spouse, 54.0% had primary and secondary school education, and 42.0% could not work due to their current health condition. From a clinical perspective, it was determined that 78% of the transplants were kidney transplants, and 41.3% were more than 4 years after transplantation. 74.3% of the transplants were from living donors. The mean score of the immunosuppressive medication compliance scale was determined to be 40.91±4.09. In the qualitative data analysis of the study, factors affecting medication adherence were examined and the themes of "individual factors", "complexity of the regimen" and "social support resources" were obtained. The sub-themes of the individual factors theme are reluctance, hopelessness and addiction; Sub-themes of the complexity of the regimen theme are drug side effects and polypharmacy; The sub-themes of the social support resources theme are loneliness and family pressure.

Conclusions: The factors influencing medication adherence among organ transplant recipients have been investigated, revealing that adherence levels vary significantly depending on various factors. These findings underscore the importance of tailored care strategies and individualized support approaches.

Keywords

• Transplantation
• medication adherence
• nursing
• mixed-methods study

References

1. 1. Lerut J, Iesari S, Foguenne M, Lai Q. Hepatocellular cancer and recurrence after liver transplantation: what about the impact of immunosuppression? Transl Gastroenterol Hepatol. 2017;2:80. doi: 10.21037/tgh.2017.09.06.
2. 2. Wojciechowski D, Wiseman A. Long-Term Immunosuppression Management: Opportunities and Uncertainties. Clin J Am Soc Nephrol. 2021;16(8):1264-1271. doi: 10.2215/CJN.15040920.
3. 3. Oweira H, Ramouz A, Ghamarnejad O, et al. Risk Factors of Rejection in Renal Transplant Recipients: A Narrative Review. J Clin Med. 2022;11(5):1392. doi: 10.3390/jcm11051392.
4. 4. Gandolfini I, Palmisano A, Fiaccadori E, Cravedi P, Maggiore U. Detecting, preventing and treating non-adherence to immunosuppression after kidney transplantation. Clin Kidney J. 2022;15(7):1253-1274. doi: 10.1093/ckj/sfac017.
5. 5. Shafiekhani M, Shahabinezhad F, Tavakoli Z, et al. Quality of life associated with immunosuppressant treatment adherence in liver transplant recipients: A cross-sectional study. Front Pharmacol. 2023;14:1051350. doi: 10.3389/fphar.2023.1051350.
6. 6. Malek-Hosseini SA, Habibzadeh F, Nikeghbalian S. Shiraz Organ Transplant Center: The Largest Liver Transplant Center in the World. Transplantation. 2019;103(8):1523-1525. doi: 10.1097/TP.0000000000002581.
7. 7. Tang J, Kerklaan J, Wong G, et al. Perspectives of solid organ transplant recipients on medicine-taking: Systematic review of qualitative studies. Am J Transplant. 2021;21(10):3369-3387. doi: 10.1111/ajt.16613.
8. 8. Wang JH, Skeans MA, Israni AK. Current Status of Kidney Transplant Outcomes: Dying to Survive. Adv Chronic Kidney Dis. 2016;23(5):281-286. doi: 10.1053/j.ackd.2016.07.001.

9. 9. Moradi O, Karimzadeh I, Davani-Davari D, Shafiekhani M, Sagheb MM. Pattern and associated factors of adherence to immunosuppressive medications in kidney transplant recipients at a referral center in Iran. Patient Prefer Adherence. 2019;13:729-738. doi: 10.2147/PPA.S198967.
10. 10. Ahmed R, Aslani P. What is patient adherence? A terminology overview. Int J Clin Pharm. 2014;36(1):4-7. doi: 10.1007/s11096-013-9856-y.
11. 11. Koken ZO, Talas MS, Gokmen D. Development and Psychometric Testing of the Turkish Immunosuppressive Medication Adherence Scale. Turkish J Nephrol. 2019;28(2): 120-126. doi: 10.5152/turkjnephrol.2019.3371.
12. 12. Gokoel SRM, Gombert-Handoko KB, Zwart TC, van der Boog PJM, Moes DJAR, de Fijter JW. Medication non-adherence after kidney transplantation: A critical appraisal and systematic review. Transplant Rev (Orlando). 2020;34(1):100511. doi: 10.1016/j.trre.2019.100511.
13. 13. Muduma G, Shupo FC, Dam S, et al. Patient survey to identify reasons for non-adherence and elicitation of quality of life concepts associated with immunosuppressant therapy in kidney transplant recipients. Patient Prefer Adherence. 2016;10:27-36. doi: 10.2147/PPA.S96086.
14. 14. Lwanga SK, Lemeshow S, World Health Organization. Sample size determination in health studies: a practical manual. World Health Organization, 1991.
15. 15. Joseph ML. Innovativeness ın nursing: a phenomenological and constructivist study. Capella University, Dissertation 2007. http://www.kutuphane.istanbul.edu.tr/everitaban.html
16. 16. Polit DF, Beck CT. Essentials of Nursing Research. 6th Edition, Lippincott William & Wilkins: Philadelphia. 2001.
17. 17. Aksayan S, Bahar Z, Seviğ Ü. Hemşirelikte Araştırma İlke Süreç ve Yöntemleri. İ. Erefe (Ed.), İstanbul: Odak Ofset, 2002.
18. 18. Braun V, Clarke V. What can "thematic analysis" offer health and wellbeing researchers? Int J Qual Stud Health Well-being. 2014;9:26152. doi: 10.3402/qhw.v9.26152.
19. 19. Köken ZÖ, Karahan S, Sezer R E, Abbasoğlu O. [Immunosuppressive Medication Adherence in Liver Transplant Patients: A Single Center Experience]. Ahi Evran Medical Journal. 2020;4(3):88-95. [Article in Turkish]
20. 20. Jain M, Venkataraman J, Reddy MS, Rela M. Determinants of Medication Adherence in Liver Transplant Recipients. J Clin Exp Hepatol. 2019c;9(6):676-683. doi: 10.1016/j.jceh.2019.03.003.
21. 21. Yoon ES, Hur S, Curtis LM, et al. A Multifaceted Intervention to Improve Medication Adherence in Kidney Transplant Recipients: An Exploratory Analysis of the Fidelity of the TAKE IT Trial. JMIR Form Res. 2022;6(5):e27277. doi: 10.2196/27277.
22. 22. Stewart SF, Moon Z, Horne R. Medication nonadherence: health impact, prevalence, correlates and interventions. Psychol Health. 2023;38(6):726-765. doi: 10.1080/08870446.2022.2144923.
23. 23. West LM, Borg Theuma R, Cordina M. The 'Necessity-Concerns Framework' as a means of understanding non-adherence by applying polynomial regression in three chronic conditions. Chronic Illn. 2020;16(4):253-265. doi: 10.1177/1742395318799847.
24. 24. Eriksen CU, Kyriakidis S, Christensen LD, et al. Medication-related experiences of patients with polypharmacy: a systematic review of qualitative studies. BMJ Open. 2020;10(9):e036158. doi: 10.1136/bmjopen-2019-036158.
25. 25. Franchi C, Ludergnani M, Merlino L, et al. Multiple Medication Adherence and Related Outcomes in Community-Dwelling Older People on Chronic Polypharmacy: A Retrospective Cohort Study on Administrative Claims Data. Int J Environ Res Public Health. 2022;19(9):5692. doi: 10.3390/ijerph19095692.
26. 26. Lavrador M, Cabral AC, Castel-Branco M, Figueiredo IV, Fernandez-Llimos F. Polypharmacy and medication adherence. In: Aging. From Fundamental Biology to Societal Impact. Oliveira P, Malva JO. eds., Academic Press. 2023; pp.435-453. doi: 0.1016/B978-0-12-823761-8.00014-8