Practice patterns to improve pre and post-transplant medication adherence in heart transplant centres: a secondary data analysis of the international BRIGHT study

Abstract

Background:

As medication non-adherence is a major risk factor for poor post-transplant outcomes, we explored how adherence is assessed, enhanced and integrated across the transplant continuum.

Aim:

The aim of this study was to study practice patterns regarding pre- and post-transplant medication adherence assessment and interventions in international heart transplant centres.

Methods:

We used data from the Building Research Initiative Group: chronic illness management and adherence in heart transplantation (BRIGHT) study, a cross-sectional study conducted in 36 heart transplant centres in 11 countries. On a 27-item questionnaire, 100 clinicians (range one to five per centre) reported their practice patterns regarding adherence assessment and intervention strategies pre-transplant, immediately post-transplant, less than one year, and one or more year post-transplant. Educational/cognitive, counselling/behavioural and psychosocial/affective strategies were assessed. Clinicians’ responses (intervention present vs. absent; or incongruence in reporting intervention) were aggregated at the centre level.

Results:

The adherence assessment method most commonly used along the transplant continuum was questioning patients (range 75–88.9%). Pre-transplant, all three categories of intervention strategy were applied. Providing reading materials (82.9%) or instructions (68.6%), involving family or support persons in education (91.4%), and establishing partnership (91.4%) were used most frequently. Post-transplant, strategies closely resembled those employed pre-transplant. Training patients (during recovery) and cueing were more often applied during hospitalisation (74.3%). After the first year post-transplant, except for motivational interviewing (25.7–28.6%), the number of strategies decreased.

Conclusions:

Across the transplant continuum, diverse adherence interventions are implemented; however, post-transplant, the frequency of adherence interventions decreases. Therefore, increased investment is necessary in long-term adherence interventions.

Keywords

Heart transplantation medication adherence practice patterns adherence assessment

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References

Dobbels

De Geest

Van Cleemput

et al . Effect of late medication non-compliance on outcome after heart transplantation: a 5-year follow-up. J Heart Lung Transplant 2004; 23: 1245–1251.

De Geest

Abraham

Moons

et al . Late acute rejection and subclinical noncompliance with cyclosporine therapy in heart transplant recipients. J Heart Lung Transplant 1998; 17: 854–863.

Vrijens

De Geest

Hughes

et al . A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol 2012; 73: 691–705.

Dew

DiMartini

De Vito Dabbs

et al . Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation 2007; 83: 858–873.

De Geest

Burkhalter

Bogert

et al . Describing the evolution of medication nonadherence from pretransplant until 3 years post-transplant and determining pretransplant medication nonadherence as risk factor for post-transplant nonadherence to immunosuppressives: the Swiss Transplant Cohort Study. Transpl Int 2014; 27: 657–666.

De Bleser

Dobbels

Berben

et al . The spectrum of nonadherence with medication in heart, liver, and lung transplant patients assessed in various ways. Transpl Int 2011; 24: 882–891.

Dew

Kormos

Roth

et al . Early post-transplant medical compliance and mental health predict physical morbidity and mortality one to three years after heart transplantation. J Heart Lung Transplant 1999; 18: 549–562.

Hope

et al . Association of medication adherence, knowledge, and skills with emergency department visits by adults 50 years or older with congestive heart failure. Am J Health Syst Pharm 2004; 61: 2043–2049.

Fitzgerald

Powers

et al . Impact of medication nonadherence on hospitalizations and mortality in heart failure. J Card Fail 2011; 17: 664–669.

10.

Pinsky

Takemoto

Lentine

et al . Transplant outcomes and economic costs associated with patient noncompliance to immunosuppression. Am J Transplant 2009; 9: 2597–2606.

11.

Costanzo

Dipchand

Starling

et al . The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant 2010; 29: 914–956.

12.

Berben

Bogert

Leventhal

et al . Which interventions are used by health care professionals to enhance medication adherence in cardiovascular patients? A survey of current clinical practice. Eur J Cardiovasc Nurs 2011; 10: 14–21.

13.

Berben

Dobbels

Kugler

et al . Interventions used by health care professionals to enhance medication adherence in transplant patients: a survey of current clinical practice. Prog Transplant 2011; 2: 322–331.

14.

Kirsch

Berben

Johansson

et al . Nurses’ practice patterns in relation to adherence-enhancing interventions in stem cell transplant care: a survey from the Nurses Group of the European Group for Blood and Marrow Transplantation. Eur J Cancer Care 2014; 23: 607–615.

15.

De Bleser

Matteson

Dobbels

et al . Interventions to improve medication-adherence after transplantation: a systematic review. Transpl Int 2009; 22: 780–797.

16.

Russell

. Medication noncompliance: perceptions of transplant healthcare providers. Nephrol Dial Transplant 2005; 34: 301–313.

17.

Berben

Denhaerynck

Dobbels

et al . Building research initiative group: chronic illness management and adherence in transplantation (BRIGHT) study: study protocol. J Adv Nurs 2015; 71: 642–654.

18.

Rickham

. Human experimentation. Code of ethics of the World Medical Association. Declaration of Helsinki. BMJ 1964; 2: 177.

19.

Sabaté

. Adherence to Long-Term Therapies: evidence for action. Geneva, Switzerland: World Health Organization, 2003.

20.

Haynes

Ackloo

Sahota

et al . Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2008; (2): CD000011.

21.

Roter

Hall

Merisca

et al . Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care 1998; 36: 1138–1161.

22.

Haynes

Yao

Degani

et al . Interventions to enhance medication adherence. Cochrane Database Syst Rev 2005; (4): CD000011.

23.

McDonald

Garg

Haynes

. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA 2002; 288: 2868–2879.

24.

Brar

Babakhani

Salifu

et al . Evaluation of non-adherence in patients undergoing dialysis and kidney transplantation: United States transplantation practice patterns survey. Transplant Proc 2014; 46: 1340–1346.

25.

Pisoni

Gillespie

Dickinson

et al . The Dialysis Outcomes and Practice Patterns Study (DOPPS): design, data elements, and methodology. Am J Kidney Dis 2004; 44 (5 Suppl 2): 7–15.

26.

Conn

Hafdahl

Cooper

et al . Interventions to improve medication adherence among older adults: meta-analysis of adherence outcomes among randomized controlled trials. Gerontologist 2009; 49: 447–462.

27.

De Geest

Abraham

Dunbar-Jacob

. Measuring transplant patients’ compliance with immunosuppressive therapy. West J Nurs Res 1996; 18: 595–605.

28.

Schafer-Keller

Steiger

Bock

et al . Diagnostic accuracy of measurement methods to assess non-adherence to immunosuppressive drugs in kidney transplant recipients. Am J Transplant 2008; 8: 616–626.

29.

Institute of Medicine (IOM). Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2. Washington, DC: The National Academies Press, 2014.

30.

Demonceau

Ruppar

Kristanto

et al . Identification and assessment of adherence-enhancing interventions in studies assessing medication adherence through electronically compiled drug dosing histories: a systematic literature review and meta-analysis. Drugs 2013; 73: 545–562.

31.

Coleman

Limone

Sobieraj

et al . Dosing frequency and medication adherence in chronic disease. J Manag Care Pharm 2012; 18: 527–539.

32.

Ruppar

Dobbels

Lewek

et al . Systematic review of clinical practice guidelines for the improvement of medication adherence. Int J Behav Med 2015; 22: 699–708.

33.

Chisholm-Burns

Spivey

Graff Zivin

et al . Improving outcomes of renal transplant recipients with behavioral adherence contracts: a randomized controlled trial. Am J Transplant 2013; 13: 2364–2373.

34.

Nieuwlaat

Wilczynski

Navarro

et al . Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2014; 11: CD000011.

35.

Almgren

Lennerling

Lundmark

et al . The meaning of being in uncertainty after heart transplantation – an unrevealed source to distress. Eur J Cardiovasc Nurs 2017; 16: 167–174.

36.

Lindberg

Nilsson

Zotterman

et al . Using information and communication technology in home care for communication between patients, family members, and healthcare professionals: a systematic review. Int J Telemed Appl 2013; 2013: 461829.

37.

DeVito Dabbs

Song

Myers

et al . A randomized controlled trial of a mobile health intervention to promote self-management after lung transplantation. Am J Transplant 2016; 16: 2172–2180.

38.

Rosenberger

DeVito Dabbs

DiMartini

et al . Long-term follow-up of a randomized controlled trial evaluating a mobile health intervention for self-management in lung transplant recipients. Am J Transplant 2017; 17: 1286–1293.

39.

Rijken

Jones

Heijmans

et al . Supporting self-management. In: Nolte

McKee

(eds) Caring for people with chronic conditions: a health care perspective. Berkshire: Open University Press, 2008, pp. 116–142.

40.

Bodenheimer

Wagner

Grumbach

. Improving primary care for patients with chronic illness. JAMA 2002; 288: 1775–1779.

41.

Moullec

Gour-Provencal

Bacon

et al . Efficacy of interventions to improve adherence to inhaled corticosteroids in adult asthmatics: impact of using components of the chronic care model. Respir Med 2012; 106: 1211–1225.

42.

Michie

Richardson

Johnston

et al . The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013; 46: 81–95.

43.

De Geest

Russell

Denhaerynck

et al .; on behalf of the BRIGHT study team. Multilevel factors associated with medication adherence in heart transplantation: a multi-continent cross-sectional study (BRIGHT Study). (Presentation) 17th Congress of the European Society for Organ Transplantation (ESOT). 13 September 2015. Transpl Int 2015; 28 (Suppl. 4): O84.

44.

Marsicano

Fernandes

Colugnati

FAB

et al . Multilevel correlates of non-adherence in kidney transplant patients benefitting from full cost coverage for immunosuppressives: a cross-sectional study. PLOS ONE 2015; 10: e0138869.

45.

Cajita

Denhaerynck

Dobbels

et al . Health literacy in heart transplantation: prevalence, correlates and associations with health behaviors – findings from the international BRIGHT study. J Heart Lung Transplant 2017; 36: 272–279.

46.

Hickey

Doering

Chen

et al . Clinical and gender differences in heart transplant recipients in the NEW HEART study. Eur J Cardiovasc Nurs 2017; 16: 222–229.