Compliance and noncompliance in patients with a functioning renal transplant: A multicenter study

Stuart M. Greenstein, Bonita Siegal

Research output: Contribution to journalArticle

164 Citations (Scopus)

Abstract

Background. Noncompliance with medication is a major cause of renal allograft failure among adult renal transplant patients. We summarize previous studies of noncompliance and report results of a large, multicenter survey designed to identify variables that (1) affect the likelihood of compliance with immunosuppressive medication regimens and (2) distinguish among noncompliant patients. Methods. Questionnaires were distributed to 2500 patients at 56 U.S. transplant centers. Compliance was determined by patient responses to questions concerning whether, within the previous 4 weeks, one or more doses of immunosuppressive medications had been missed. Independent variables included patient and transplant characteristics, memories of dialysis, posttransplant symptoms and beliefs, and beliefs concerning the efficacy and importance of immunosuppressants. Results. The incidence of noncompliance reported by the 1402 respondents was 22.4%. A logistic regression model that included age, occupation, time since transplant, and three medication-related beliefs was most predictive of the likelihood of compliance. Donor type and histories of diabetes and of infection entered the multivariate model when belief-related variables were excluded. Cluster analyses identified three distinct profiles of noncompliers: accidental noncompliers, invulnerables, and decisive noncompliers. Conclusions. Results of this study, which included nearly three times more patients than the largest previously reported study, can be used by clinicians to identify patients likely to become noncompliant, by researchers to develop randomized, prospective clinical trials of interventions designed to increase compliance, and by educators to tailor patient education programs.

Original languageEnglish (US)
Pages (from-to)1718-1726
Number of pages9
JournalTransplantation
Volume66
Issue number12
DOIs
StatePublished - Dec 27 1998

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Patient Compliance
Compliance
Multicenter Studies
Transplants
Kidney
Immunosuppressive Agents
Logistic Models
Medication Adherence
Patient Education
Occupations
Renal Insufficiency
Allografts
Cluster Analysis
Dialysis
Randomized Controlled Trials
Research Personnel
Tissue Donors
Incidence
Infection
Surveys and Questionnaires

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Compliance and noncompliance in patients with a functioning renal transplant : A multicenter study. / Greenstein, Stuart M.; Siegal, Bonita.

In: Transplantation, Vol. 66, No. 12, 27.12.1998, p. 1718-1726.

Research output: Contribution to journalArticle

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