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21 May 2009

Nurses’ intervention for nonadherent transplant recipients

I Milaniak, J Siwińska, F Krupa Hubner, P Przybyłowski, K Wierzbicki, J Sadowski

Ann Transplant 2009; 14(1): 66-66 :: ID: 880442


Background: Transplantation is successful and can help people with chronic
organ failure to come back to the society. But solid organ transplant recipients are chronically ill patients, because the transplantation did not fully eliminate the need for medical treatment. The transplant patient's therapeutic regimen consists of a lifelong medication regimen, including immunosuppressive drugs; monitoring for signs and symptoms related to complications; avoidance of risk factors for cardiovascular disease and cancer, avoidance of abuse/dependence of alcohol, as well as attending regular clinical checkups. Non-adherence to all aspects of this regimen is substantial. Non-adherence has been related to negative clinical outcome in view of acute rejections, graft vasculopathy, higher costs, and mortality. Objective: Evaluation by means of using the self reported Morisky score as a screening tool to identify patients, who have been non-adherent with immunosuppressant and non-immunosuprresant drug therapy.
Material/Methods: 198 patients after heart transplantation were handed out a questionnaire that included the validated 4-item Morisky Medication Adherence Scale (MMAS) (2 parts divided into immunosuppressive therapy and other drugs).
Results: The average age of participants was 50.27 years (range 23-73 years), from1 to 17 years after heart transplantation. 32% of recipients reported, that sometimes forget to take the immunosuppressive medications, 40% - other drugs. 7.6%-cut back or stopped taking their medication without telling their doctor because they felt worse or stopped taking their medications when they felt their condition was under control); other drugs - 30%. 52.3% of patients are careless of taking their immunosuppressive medications on time. Generally they do not forget to refill their prescribed medicine on time (90%). 27.69% of patients have a low motivation but have a good knowledge (95.38%); other drugs - 31% - low motivation, 27.27% - low knowledge. Our interventions: motivational interviewing, patient reminder systems, psychosocial support plan, family motivational assessment, disease-specific education and consequences of non-adherence - Medication regimen education, why medication is needed, what to do.

Keywords: Heart Transplantation, clinical outcome

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358