Multilevel Correlates of Immunosuppressive Nonadherence in Kidney Transplant Patients the Multicenter ADHERE BRAZIL Study

Sanders-Pinheiro, Helady and Colugnati, Fernando A. B. and Denhaerynck, Kris and Marsicano, Elisa O. and Medina, José O. P. and De Geest, Sabina and Adhere Brazil Study Team, . (2021) Multilevel Correlates of Immunosuppressive Nonadherence in Kidney Transplant Patients the Multicenter ADHERE BRAZIL Study. Transplantation, 105 (1). pp. 255-266.

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Official URL: https://edoc.unibas.ch/76598/

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Immunosuppressive nonadherence is a risk factor for worse outcomes after kidney transplantation (KT). Brazil, having the world's largest public, fully covered transplantation system and the second highest KT volume worldwide, provides a unique setting for studying multilevel correlates of nonadherence (patient, healthcare provider, transplant center, and healthcare system levels) independent of patients' financial burden.; By applying a multistage sampling approach, we included 1105 patients from 20 KT centers. Nonadherence to immunosuppressives (implementation phase) was defined as any deviation in taking or timing adherence and/or dose reduction assessed by the BAASIS. Based on Bronfenbrenner's ecological model, we assessed multilevel factors using established instruments and measures specifically developed for this study and analyzed their independent contribution to nonadherence by performing sequential logistic regression analysis.; The nonadherence prevalence rate was 39.7%. The following factors were independently associated with nonadherence: Patient level- having a stable partner (OR:0.75; CI:0.58-0.97), nonadherence to appointments (OR:2.98; IC:2.03-4.39), and nonadherence to physical activity recommendations (OR:1.84; CI:1.38-2.46); and Transplant center level - satisfaction with the waiting room structure (OR:0.54;CI:0.42-0.71), consultation >30 minutes (OR:1.60; CI:1.19-2.14), adequacy of the consultation frequency (OR:0.62; CI:0.43-0.90), and centers with >500 beds (OR:0.58; CI:0.46-0.73).; As the first multicenter study assessing multilevel correlates of nonadherence in KT, our findings point to the need for multilevel interventions beyond the patient level, targeting transplant center practice patterns as an approach to tackle nonadherence.
Faculties and Departments:03 Faculty of Medicine > Departement Public Health > Institut für Pflegewissenschaft
UniBasel Contributors:Denhaerynck, Kris and De Geest, Sabina M.
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Lippincott Williams & Wilkins
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:30 Dec 2020 10:47
Deposited On:30 Dec 2020 10:47

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