PMID- 21856247
OWN - NLM
STAT- MEDLINE
DCOM- 20120910
LR  - 20151119
IS  - 1934-8150 (Electronic)
IS  - 1551-7411 (Linking)
VI  - 8
IP  - 3
DP  - 2012 May-Jun
TI  - Rurality and other factors associated with adherence to immunosuppressant 
      medications in community-dwelling solid-organ transplant recipients.
PG  - 228-39
LID - 10.1016/j.sapharm.2011.04.001 [doi]
AB  - BACKGROUND: Data on immunosuppressant adherence of community-dwelling adult 
      solid-organ transplant recipients (SOTRs) from rural populations in the United 
      States are limited. Therefore, understanding the association of rurality and 
      other factors of immunosuppressant adherence will help providers design and 
      deliver patient-centered adherence enhancing interventions. OBJECTIVES: The 
      objective was to examine factors associated with a previously validated 4-item 
      Immunosuppressant Therapy Adherence Scale (ITAS) score in community-dwelling 
      adult SOTRs who received a transplant from an academic center in the Midwestern 
      United States. METHODS: For this observational study, cross-sectional survey data 
      (patient demographic, medical condition, immunosuppressant therapy, and 
      self-reported ITAS) received from adult SOTRs aged 19 years or older with other 
      data from an academic transplant center's database were merged. Using 
      multivariate logistic regression, significant SOTR characteristics associated 
      with being adherent (ITAS score=12) versus nonadherent (ITAS score <12) were 
      examined. RESULTS: The survey response rate was 30% (n=556/1827). Those SOTRs 
      responding (n=556) had a kidney (48%), liver (47%), or other (4.5%) transplant. 
      They were more likely to be 50- to 64-year olds (52%), men (55%), white (90%), 
      metroresident (59%), with an annual income less than $55,000. The SOTRs were 
      living with a transplant for 6.3 years (median), reported excellent-to-good 
      health status (77%), and received different immunosuppressant regimens. More than 
      half of the SOTRs (58%) were adherent. In multivariate analyses, compared with 
      patients aged 65 years or older, younger patients, nonmetro rural- versus 
      metroresident, and those having more (>/=6) versus less (<6) comorbidities were 
      significantly less likely to report adherence. SOTRs receiving tacrolimus-based 
      combination immunosuppressant versus tacrolimus alone were more likely to report 
      adherence. CONCLUSIONS: When designing and delivering patient care-centered 
      interventions including those that use technology to increase immunosuppressant 
      adherence, providers need to consider rural residence besides other 
      well-established patient factors (younger age, immunosuppressant drug, and 
      comorbidities) of nonadherence.
CI  - Copyright (c) 2012 Elsevier Inc. All rights reserved.
FAU - Sankaranarayanan, Jayashri
AU  - Sankaranarayanan J
AD  - Department of Pharmacy Practice, College of Pharmacy, University of Nebraska 
      Medical Center, Nebraska Medical Center, Omaha, NE 68198-6045, USA. 
      jsankara@unmc.edu
FAU - Collier, Dean
AU  - Collier D
FAU - Furasek, Anne
AU  - Furasek A
FAU - Reardon, Tom
AU  - Reardon T
FAU - Smith, Lynette M
AU  - Smith LM
FAU - McCartan, Megan
AU  - McCartan M
FAU - Langnas, Alan N
AU  - Langnas AN
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Res Social Adm Pharm
JT  - Research in social & administrative pharmacy : RSAP
JID - 101231974
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - *Community Pharmacy Services
MH  - Cross-Sectional Studies
MH  - Drug Therapy, Combination
MH  - Female
MH  - Graft Rejection/immunology/*prevention & control
MH  - Graft Survival/*drug effects
MH  - Health Care Surveys
MH  - *Health Knowledge, Attitudes, Practice
MH  - Humans
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Logistic Models
MH  - Male
MH  - *Medication Adherence
MH  - Middle Aged
MH  - Midwestern United States
MH  - Odds Ratio
MH  - *Organ Transplantation/adverse effects
MH  - Residence Characteristics
MH  - Risk Assessment
MH  - Risk Factors
MH  - *Rural Health Services
MH  - Socioeconomic Factors
MH  - Surveys and Questionnaires
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2011/08/23 06:00
MHDA- 2012/09/11 06:00
CRDT- 2011/08/23 06:00
PHST- 2011/02/27 00:00 [received]
PHST- 2011/04/25 00:00 [revised]
PHST- 2011/04/26 00:00 [accepted]
PHST- 2011/08/23 06:00 [entrez]
PHST- 2011/08/23 06:00 [pubmed]
PHST- 2012/09/11 06:00 [medline]
AID - S1551-7411(11)00046-5 [pii]
AID - 10.1016/j.sapharm.2011.04.001 [doi]
PST - ppublish
SO  - Res Social Adm Pharm. 2012 May-Jun;8(3):228-39. doi: 
      10.1016/j.sapharm.2011.04.001.