Table 4:
Studies exploring correlates to adherence
| Author/Year | Measure of adherence | Variables explored | Main outcomes |
|---|---|---|---|
| Blanca Martinez Perez (2013)14 | Morisky-Green test and immunosuppressant drug levels | Higher age (years) | Not significant: (OR 1.5; 95% CI: 0.7 – 3.3; p = 1) |
| Sex (binary) | Not significant: (OR 1; 95% CI: 0.4 – 2.3; p = 0.998) | ||
| Urgent vs elective transplant (binary) | Not significant: (OR 0.8; 95% CI: 0.4 – 1.5; p = 1) | ||
| Dyslipidemia (binary) | Not significant: (OR 1; 95% CI: 0.99 – 1.01; p = 0.794) | ||
| Hypertension (binary) | Not significant: (OR 0.9; 95% CI: 0.5–1.4; p =0.442) | ||
| Diabetes mellitus (binary) | Not significant: (OR 1.6; 95% CI: 0.9–2.9; p =0.145) | ||
| Renal failure (binary) | Not significant: (OR 1.9; 95% CI: 0.6–3; p = 0.175) | ||
| Brocks (2017)15 | ITAS measure | Consumption of soft boiled or unpasteurized egg products, scored as (4 = daily; 3 = several times a week; 2 = occasionally; 1 = never) | Significantly associated with nonadherence: (r = −0.130; P < 0.01) |
| Consumption of unpasteurized milk products, scored as (4 = daily; 3 = several times a week; 2 = occasionally; 1 = never) | Significantly associated with nonadherence: (r = −0.128; P < 0.01) | ||
| Higher SF-12 Mental Health Score (units) ranging 0–100 where 0 represents low and 100 represents high level of health. | Significantly associated with adherence: (r = 0.016; 95% CI: 0.003–0.028; p = 0.015) | ||
| Higher age (years) | Significantly associated with adherence: (r = 0.017; 95% CI: 0.08–0.026; p < 0.001) | ||
| Perceptions/miscellaneous | 74.8% noted being at least slightly handicapped by adverse drug effects; fewer than 15% of the group believed any of the following: “I need to take medication too often,” “I need to take too many pills at 1 time,” “I do not know if immunosuppression helps,” “My immunosuppression sometimes runs out,” “Remembering to take immunosuppression is hard,” and “I neglect taking immunosuppression.” | ||
| De Geest (1998)25 | Electronic pill bottle monitor | Appointment noncompliance rates | Appointment noncompliance rates were higher in minor (28.6%) and moderate (11.1%) subclinical noncompliers compared to excellent compliers (3.6%) (p = 0.03). |
| Self efficacy with medication taking as rated on questionnaire on a 5-point scale | Self efficacy was worst in the minor subclinical noncompliers (mean 4.41; Q1: 4.30, Q3: 4.81) and best in the excellent compliers (mean 4.85; Q1: 4.70, Q3: 5.00); Moderate compliers: (mean 4.81; Q1: 4.70, Q3: 4.89) (p = 0.04). | ||
| Miscellaneous | Clusters did not differ significantly on demographic data, BMI, perceived social support, symptom frequency, symptom distress, depressive symptomatology, knowledge of the therapeutic regimen, cardiac functional status, and perceived health status. | ||
| De Geest (2014)16 | Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) | Greater time since transplant | In the adjusted model: Significantly associated with nonadherence: (aOR: 1.05; 95% CI: 1.01–1.08) |
| Denhaerynck (2018)32 | Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) | Greater barriers to taking immunosuppression as prescribed, scored 1 (never) to 5 (always) | In the multiple sequential regression model, Significantly associated with nonadherence: (OR = 11.48; 95% CI: 6.66–21.05; p < 0.0001) |
| Currently or recently smoking or having stopped less than a year ago | Significantly associated with nonadherence: (OR: 2.19; 95% CI: 1.35–3.56; p = 0.002) | ||
| Medication pick-up at physician’s office | Significantly associated with nonadherence: (OR = 2.31; 95% CI: 1.24–4.31; p = 0.008) | ||
| Higher monthly immunosuppression cost, scored as 1 ($0–$20), 2 ($20.01–$60), 3 ($60.01–%110) and 4 (>$110) | Significantly associated with nonadherence: (OR = 1.16; 95% CI: 1.02–1.33; p = 0.03) | ||
| Higher frequency of having someone to help read health-related materials, scored 1 (none of the time) to 5 (all of the time) | Significantly associated with adherence: (OR = 0.85; 95% CI: 0.76–0.95; p = 0.004) | ||
| Clinicians reporting nonadherent patients are targeted with adherence interventions, scored 1 (never) to 4 (always) | Significantly associated with adherence: (OR = 0.66; 95% CI: 0.48–0.91; p = 0.01) | ||
| Epstein (2014)26 | Immunosuppressant Therapy Adherence Scale (ITAS) | Chance LOC, defined as feelings of control over health outcomes, measured via the Multidimensional Health Locus of Control tool | Significantly inversely related to occassional missed doses of immunosuppressant medications: (OR 1.1527; 95% CI: 1.0394 – 1.2792); p = 0.0071) |
| African American race | Significant: (p=0.0026). No other data provided. | ||
| Grady (2016)28 | Assessment of Problems with the Heart Transplant Regimen | Female gender | Significantly associated with adherence: (0.05 point difference; 95% CI: 0.02–0.08; p = 0.005) |
| Higher age | Significantly associated with nonadherence: (−0.003 point difference; 95% CI: 0.01 – 0.09; p < 0.0001) | ||
| Idiopathic etiology of heart failure | Significantly associated with adherence: (0.05 point difference; 95% CI: 0.01–0.09; p =0.028) | ||
| Ischemic etiology of heart failure | Significantly associated with adherence: (0.06 point difference; 95% CI: 0.02–0.11; p = 0.003) | ||
| Miscellaneous | “No psychiatric condition”, “No orthopedic illness”, and “No diabetes” were not significantly associated with adherence | ||
| Grady (1998)29 | Assessment of Problems with Heart Transplant Regimen | Higher self-care disability as noted on the Sickness Impact Profile | Significantly associated with nonadherence: (r = 0.32; p < 0.0001) |
| Higher number of complications between 9 and 12 months after transplant as noted in the medical record | Significantly associated with nonadherence: (r = 0.25; p = 0.005) | ||
| Grady (1999)30 | Assessment of Compliance with Transplant Regimen | Life satisfaction as collected from the Quality of Life Index | Significantly associated with adherence: (r = −0.42; p ≤0.0001) |
| Milaniak (2014)23 | Transplant Effects Questionnaire (TxEQ) | Comprehensibility (the idea that confronted stimuli are are structured and predictable) collected from the Sense of Coherence instrument, Polish version | Trend toward adherence but not significant (r = 0.253; p =0.089) |
| Shamaskin (2012)31 | Assessment of Problems with Heart Transplant Regimen | Higher age, divided into older (>60), middle aged between 45–59 and younger (<45). | Significantly associated with adherence (F(2,234.75) = 9.98, p < 0.001) Values were 0.14 (SD 0.12) for younger patients, 0.12 (SD 0.10) for middle aged, and 0.08 (SD 0.07) for older patients |
| Miscellaneous | Higher age was significantly associated with perceived difficulty with adherence (F(2,552) = 11.97; p < 0.001). Values were 0.26 (SD 0.20) for younger patients, 0.24 (SD 0.19) for middle aged and 0.16 (SD 0.17) for older patients | ||
| Shemesh (2017)36 | Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) | Higher age (years) | Significantly associated with adherence (b=0.036, p=0.04) |
| Greater guilt feelings regarding the heart donation, defined on a scale from 0 (not at all), 1 (slightly), 2 (moderately), 3 (very), and 4 (greatly) | Significantly associated with nonadherence (b=−1.497, p=0.037) | ||
| Time since transplantation as obtained from the medical record | Significantly associated with nonadherence (b=−0.008; p = 0.027) | ||
| Miscellaneous | There was no difference in adherence between men/women (χ2(1)=2.02; p=0.16), employment/student status (χ2(1)=3.32; p = 0.07), transplant center (χ2(1)=0.14, p=0.71) or initial support with LVAD/BiVAD/neither (χ2(1)=.25, P=0.62). | ||
| Vitinius (2019)24 | Medication experience scale for immunosuppressants (MESI) | Anxiety and depression as measured by the HADS-D tool: Seven items form a depression subscale and the other seven items an anxiety subscale. The items are scored from 0 to 3. | Higher scores 6 months after transplant not significantly associated with adherence: (r = 0.44; P = 0.199 and r = 0.54; P = 0.106, respectively) |
| Higher depression scores via the Patients Health Questionnaire (PHQ-D) score: assesses symptoms according to classifications in the DSM-IV | Significantly associated with nonadherence: (r = 0.68, p = 0.031) | ||
| Higher Transplant Evaluation Rating Scale (TERS) score, that represents psychosocial functioning. Scores range from 26.5 to 79.5 and higher represents worse functioning. | Not significantly associated with adherence immediately after transplantation (r = −0.11, P = 0.764) | ||
| However, was significantly associated with nonadherence 6 months after transplantation (r = 0.84; p = 0.001) | |||
| Zhang (2019)35 | Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) | Lower monthly income (<3000 Chinese Yuan) as obtained via questionnaire. | Significantly associated with nonadherence (OR: 3.11; 95% CI: 1.58–6.12; p=0.001) |
| Number of prescribed concomitant drugs gathered via medical record and patient interview | Significantly associated with nonadherence (OR: 1.23; 95% CI, 1.12–1.50; p=0.003) | ||
| Higher concerns about immunosuppressants as gathered through the Belief Medication Questionnaire (BMQ) Each item is scored on a 5-point scale (1=strongly disagree, 5=strongly agree) and is summed resulting in a score for each subscale. High scores indicate a strong belief in the necessity and low concern for the use of immunosuppressants. | Significantly associated with nonadherence (OR: 1.09; 95% CI, 1.01–1.18; p=0.031) | ||
| Miscellaneous | Noncompliance was significantly associated with less than a high school education, (53.6% vs. 37.4%; p=0.037), greater likelihood of living in a rural area (36.2% vs. 20.2%; p=0.021); lower median anxiety scores (10.0 vs. 12.0, p=0.041), a poorer Physical Component Summary (PCS) score (44.6 vs. 48.0, p=0.002) and lower Mental Component Summary (MCS) score: (44.4 vs. 49.1, p=0.001) though none were statistically significant in the final logistic model. |
OR: Odds ratio; aOR: Adjusted odds ratio; LVAD: Left-ventricular assist device; BiVAD: bi-ventricular assist device; DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition