Kris Denhaerynck

Prevalence, consequences, and determinants of nonadherence in adult renal transplant patients: a literature review

This literature review summarizes the evidence on the prevalence, determinants, clinical and economic consequences of nonadherence with immunosuppressive drugs in renal transplant patients. A literature search yielded 38 articles measuring nonadherence by self‐report, collateral report, assay, refill prescriptions or electronic monitoring. The weighted mean prevalence of self‐reported nonadherence was 28%. Nonadherence is associated with poor clinical outcomes, contributing to 20% of late acute rejection episodes and 16% of the graft losses (weighted means). In addition, nonadherence results in lower lifetime costs because of shorter survival, yet also in a lower number of quality adjusted life years. Consistent determinants of nonadherence were younger age, social isolation, and cognitions (e.g. low self‐efficacy, certain health beliefs). Determinants concerning the health care system/team seem to be underinvestigated. Because the evidence summarized in this review is based on older immunosuppressive regimens, further research should focus on prevalence, determinants and consequences of nonadherence with newer immunosuppressive regimens.

Interventions for preventing falls in acute and chronic care hospitals: a systematic review and meta-analysis.

OBJECTIVES: To determine the characteristics and the effectiveness of hospital fall prevention programs.

The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis.

OBJECTIVES: To examine how geriatric evaluation and management units (GEMUs) are organized and to examine the effectiveness of admission on a GEMU.

Prevalence and Risk Factors of Non‐Adherence with Immunosuppressive Medication in Kidney Transplant Patients

Non‐adherence with immunosuppressive regimen is a major risk factor for poor outcome after kidney transplantation. Identifying patients at risk for non‐adherence requires understanding the risk factors for non‐adherence. This prospective study included a convenience sample of 249 adult kidney transplant patients >1 year post‐transplant. Non‐adherence was monitored electronically using MEMS®. Selected socio‐economic, therapy‐, patient‐, condition‐ and healthcare team‐related risk factors for non‐adherence were assessed. Period prevalences were expressed as the percent of prescribed doses taken (taking adherence), the percent of correctly dosed days (dosing adherence), the percentage of inter‐dose intervals not exceeding 25% of the prescribed interval (timing adherence), and the number of drug holidays per 100 days (no intake for > 48 h if once daily or for > 24 h if twice daily intake). Testing occurred by simple mixed logistic regression analysis. Factors significant after correction for multiple testing were entered into a multiple logistic regression model. Mean taking, dosing, timing adherence, and drug holidays were 98%, 96%, 93%, and 1.1 days, respectively. Non‐adherence was associated with lower self‐efficacy, higher self‐reported non‐adherence, no pillbox usage, and male gender. Adherence declined between Monday and Sunday. This study provides a framework for identifying patients at risk for non‐adherence and for developing adherence‐enhancing interventions.

Supporting medication adherence in renal transplantation (SMART): a pilot RCT to improve adherence to immunosuppressive regimens

Abstract:  Background:  Although non‐adherence to an immunosuppressive regimen (NAH) is a major risk factor for poor outcome after renal transplantation (RTx), very few studies have examined non‐adherence intervention in this context. This pilot randomized controlled trial (RCT) tested the efficacy of an educational–behavioural intervention to increase adherence in non‐adherent RTx patients. We also assessed how NAH evolves over time.

Examining assumptions regarding valid electronic monitoring of medication therapy: development of a validation framework and its application on a European sample of kidney transplant patients

BackgroundElectronic monitoring (EM) is used increasingly to measure medication non-adherence. Unbiased EM assessment requires fulfillment of assumptions. The purpose of this study was to determine assumptions needed for internal and external validity of EM measurement. To test internal validity, we examined if (1) EM equipment functioned correctly, (2) if all EM bottle openings corresponded to actual drug intake, and (3) if EM did not influence a patients normal adherence behavior. To assess external validity, we examined if there were indications that using EM affected the sample representativeness.MethodsWe used data from the Supporting Medication Adherence in Renal Transplantation (SMART) study, which included 250 adult renal transplant patients whose adherence to immunosuppressive drugs was measured during 3 months with the Medication Event Monitoring System (MEMS). Internal validity was determined by assessing the prevalence of nonfunctioning EM systems, the prevalence of patient-reported discrepancies between cap openings and actual intakes (using contemporaneous notes and interview at the end of the study), and by exploring whether adherence was initially uncharacteristically high and decreased over time (an indication of a possible EM intervention effect). Sample representativeness was examined by screening for differences between participants and non-participants or drop outs on non-adherence.ResultsOur analysis revealed that some assumptions were not fulfilled: 1) one cap malfunctioned (0.4%), 2) self-reported mismatches between bottle openings and actual drug intake occurred in 62% of the patients (n = 155), and 3) adherence decreased over the first 5 weeks of the monitoring, indicating that EM had a waning intervention effect.ConclusionThe validity assumptions presented in this article should be checked in future studies using EM as a measure of medication non-adherence.

Non-adherence to immunosuppressive medication in renal transplant recipients within the scope of the integrative model of behavioral prediction: a cross-sectional study

Schmid‐Mohler G, Pechula Thut M, Wüthrich RP, Denhaerynck K, De Geest S. Non‐adherence to immunosuppressive medication in renal transplant recipients within the scope of the integrative model of behavioral prediction: a cross‐sectional study.
Clin Transplant 2009 DOI: 10.1111/j.1399‐0012.2009.01056.x
© 2009 John Wiley & Sons A/S.

Characteristics and Effectiveness of Fall Prevention Programs in Nursing Homes: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

To determine characteristics and effectiveness of prevention programs on fall‐related outcomes in a defined setting.

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.

Although medication nonadherence (MNA) is a major risk factor for poor outcomes, the evolution of MNA from pre‐ to 3 years post‐transplant among the four major organ transplant groups remains unknown. Therefore, this study described this evolution and investigated whether pretransplant MNA predicts post‐transplant immunosuppressive medication nonadherence (IMNA). Adult participants (single transplant, pretransplant and ≤1 post‐transplant assessment, using medications pretransplant) in the Swiss Transplant Cohort Study (a prospective nation‐wide cohort study) were included. Nonadherence, defined as any deviation from dosing schedule, was assessed using two self‐report questions pretransplant and at 6, 12, 24 and 36 months post‐transplant. Nonadherence patterns were modelled using generalized estimating equations. The sample included 1505 patients (average age: 52.5 years (SD: 13.1); 36.3% females; 924 renal, 274 liver, 181 lung, 126 heart). The magnitude and variability of self‐reported MNA decreased significantly from pretransplant to 6 months post‐transplant (OR = 0.21; 95% CI: 0.16–0.27). Post‐transplant IMNA increased continuously from 6 months to 3 years post‐transplant (OR = 2.75; 95% CI: 1.97–3.85). Pretransplant MNA was associated with threefold higher odds of post‐transplant IMNA (OR = 3.10; 95% CI: 2.29–4.21). As pretransplant MNA predicted post‐transplant IMNA and a continuous increase in post‐transplant IMNA was observed, early adherence‐supporting interventions are indispensible.

Health and ill health of asylum seekers in Switzerland : an epidemiological study

BACKGROUND Although the focus of health care for people seeking asylum in Western European countries is usually on communicable diseases, there is little data about the general health care need of this population. In this study, we investigated the actual burden of disease among asylum seekers. METHODS Data were collected from a Swiss Health Maintenance Organisation (HMO; a type of managed care organization in which physicians act as gate keepers) that was set up specifically to provide health care for asylum seekers. The data included socio-demographic characteristics, international classification of diseases (ICD-10) diagnoses and number of clinic visits. Descriptive statistics were used to assess the types of health problems and the number of clinic visits. Logistic regression analysis was used to determine whether age, gender or country or region of origin was predictive in terms of incidence of disease as diagnosed by using ICD classifications. RESULTS The total number of asylum seekers (mean age 22 years; 38% women) enrolled in the HMO from 2000 through 2003 was 979. Half of this group came from the former country of Yugoslavia. The remainder came primarily from sub-Saharan Africa, Turkey, Iraq and Sri Lanka. The most common health problems encountered in the population included musculoskeletal diseases, respiratory diseases, depression and post-traumatic stress disorder. The prevalence of all disease clusters was significantly associated with age. One-fifth of the population did not request health care at all during the time they were enrolled in the HMO. It is not known whether those who did not visit the medical clinic did not require health care or just chose not to request clinic services. CONCLUSIONS The most frequent health problems encountered in the study population were chronic medical conditions, not communicable acute diseases. Although health care services provided to asylum seekers usually focus on episodic acute care, what this group actually needs is continuity of care.