Rurality and other factors associated with adherence to immunosuppressant medications in community-dwelling solid-organ transplant recipients

Jayashri Sankaranarayanan, Dean S Collier, Anne Furasek, Tom Reardon, Lynette M Smith, Megan McCartan, Alan Norman Langnas

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)228-239
Number of pages12
JournalResearch in Social and Administrative Pharmacy
Volume8
Issue number3
DOIs
StatePublished - May 1 2012

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Independent Living
Transplants
Immunosuppressive Agents
Tacrolimus
Transplant Recipients
Comorbidity
Midwestern United States
Therapeutics
Patient-Centered Care
Age Factors
Rural Population
Patient Compliance
Liver
Health Status
Observational Studies
Logistics

Keywords

  • Adult solid-organ transplant recipients
  • Community dwelling
  • Factors
  • Immunosuppressant adherence
  • Rurality

ASJC Scopus subject areas

  • Pharmacy
  • Pharmaceutical Science

Cite this

Rurality and other factors associated with adherence to immunosuppressant medications in community-dwelling solid-organ transplant recipients. / Sankaranarayanan, Jayashri; Collier, Dean S; Furasek, Anne; Reardon, Tom; Smith, Lynette M; McCartan, Megan; Langnas, Alan Norman.

In: Research in Social and Administrative Pharmacy, Vol. 8, No. 3, 01.05.2012, p. 228-239.

Research output: Contribution to journalArticle

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AU - Smith, Lynette M

AU - McCartan, Megan

AU - Langnas, Alan Norman

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N2 - 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.

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