Time-in-a-bottle (TIAB): a longitudinal, correlational study of patterns, potential predictors, and outcomes of immunosuppressive medication adherence in adult kidney transplant recipients.

This study examined patterns, potential predictors, and outcomes of immunosuppressive medication adherence in a convenience sample of 121 kidney transplant recipients aged 21 yr or older from three kidney transplant centers using a theory-based, descriptive, correlational, longitudinal design. Electronic monitoring was conducted for 12 months using electronic monitoring. Participants were persistent in taking their immunosuppressive medications, but execution, which includes both taking and timing, was poor. Older age was the only demographic variable associated with medication adherence (r = 0.25; p = 0.005). Of the potential predictors examined, only medication self-efficacy was associated with medication non-adherence, explaining about 9% of the variance (r = 0.31, p = 0.0006). The few poor outcomes that occurred were not significantly associated with medication non-adherence, although the small number of poor outcomes may have limited our ability to detect a link. Future research should test fully powered, theory-based, experimental interventions that include a medication self-efficacy component.

Medication adherence in older renal transplant recipients.

This project examined patterns, predictors, and outcomes of medication adherence in a convenience sample of 37 renal transplant recipients aged 55 years or older in a Mid-Southern U.S. facility using an exploratory, descriptive, longitudinal design. Electronic monitoring was conducted for 12 months using the Medication Event Monitoring System. An alarming 86% of the participants were nonadherent with medications. Four clusters of medication taking and timing patterns were identified with evening doses presenting particular challenges. Depression, self-efficacy, social support, and medication side effects did not predict medication adherence. There was no significant difference in medication adherence scores between those with and without infections. Medication adherence pattern data from electronic monitoring provides an opportunity for health care professionals to move away from blaming the patient by attempting to identify predictors for medication nonadherence. Medication dose taking and timing patterns could be explored with patients so that medication adherence interventions could target specific patient patterns.

Medication adherence and older renal transplant patients' perceptions of electronic medication monitoring.

This study evaluated older renal transplant recipients' perceptions of electronic medication monitoring and the influence of these perceptions on medication adherence. A sample of 73 older adult renal transplant recipients who used the Medication Event Monitoring System (MEMS(®)) TrackCaps for 12 months provided their perceptions of device use. Participants perceived that the MEMS had a neutral effect on their medication-taking routine (65%), believed the MEMS was practical (56%), and could not describe any instances in which using the MEMS was difficult (56%). No significant difference in medication adherence was found between those who perceived the MEMS's influence negatively/neutrally and those who perceived the MEMS positively (p = 0.22). Medication adherence data from older adult renal transplant recipients can be used regardless of their perceptions of the MEMS's influence on their medication taking without biasing medication adherence data.

Relationships between sex, race, and social class and social support networks in kidney, liver, and pancreas transplant recipients.

CONTEXT: The contribution of social support networks to the recovery of transplant recipients is an important assessment in measuring improved physical and psychosocial well-being. Social support networks are described by structure, type, and function. OBJECTIVES: (1) To describe the levels of structure (size, formal and informal support), type (concrete, emotional, and informational), and function (criticalness, direction, closeness, frequency, and duration) of the social support network and (2) to examine the relationships between individual characteristics of sex, race, and social class and social support networks. METHODS: This exploratory-descriptive study was done in a Mid-south transplant center. A total of 258 kidney, liver, and pancreas transplant recipients participated, 61% of whom were less than 50-years-old. Instruments included a demographic questionnaire, the social support network pie chart, and the social support network grid. Descriptive statistics and analysis of variance were used with a .05 significance level. RESULTS: The social support network comprised extended family (67%), with a mean of 13.68 members. Emotional support was the most prevalent type of support reported. The mean (SD) duration of support was 7.9 (4.9) years. Sex, race, and social class had no main relationships with structure and type of support. However, women had a main effect with closeness (F = 4.98, P < .03) and African Americans had significantly higher levels of frequency of support (F = 7.51, P < .01) and longer duration of support (F = 9.07, P < .01) than did whites. Social and nursing intervention may improve the network closeness in males and may also augment support frequency and duration for whites.

Contribution of post-transplant social support to the quality of life of transplant recipients.

With advances in medicine and pharmacology, post-transplant quality of life (QoL) has become a major concern of researchers. In social work transplant practice, provision of social support towards QoL warrants attention. The purposes of this study were (1) to describe the social support networks of kidney, liver, and pancreas transplant recipients during the post-transplant phase of their recovery, and (2) to examine the correlations between the types and nature of social support networks and the QoL of these transplant recipients. We conducted an exploratory-descriptive study in a US university's transplant clinic. Instruments were the Social Network Map, Adult Self-Image Scale, Sickness Impact Profile, and Quality of Life Index. Descriptive statistics, and correlation analyses were used with a significance level of .05. We observed correlations between concrete and emotional support, and direction, closeness and duration of support, and QoL. Based on our findings, we discussed implications for research and practice.

Differences in quality of life before transplantation among transplant recipients with respect to selected socioeconomic variables.

PURPOSE: To examine differences in quality of life before transplantation among transplant recipients with respect to a selected set of socioeconomic variables related to household/housing, family social and health history, and availability and use of community resources. METHODS: An exploratory-descriptive study in a US university's transplant clinic. Sample included 249 kidney, liver, and pancreas transplant recipients aged 18 years or older. Instruments were a socioeconomic data questionnaire, the Sickness Impact Profile, the Adult Self-Image Scale, the Quality of Life Index, and a general quality of life scale. Descriptive statistics and analysis of variance with Bonferroni adjustment were used with a significance level of .05. Effect sizes were estimated. RESULTS: Quality of life did not differ significantly for any variable except for the use of private insurance combined with public health insurance. Such coverage was associated with significantly better scores on the psychosocial and total dimensions of the Sickness Impact Profile, indicating better health before transplantation. CONCLUSION: Researchers must first explore why a mix of private and public health insurance is associated with a higher quality of life and second reexamine whether these results occur at other transplant centers. These results also provide direction for social work professionals as they counsel patients in an attempt to help patients achieve a better psychosocial and physical quality of life before transplantation.

A comparative study of quality of life among the age groups of kidney transplant recipients.

CONTEXT: Quality of life and transplant age are 2 major concerns of professionals and researchers. Both variables are contemplated in transplant allocation decisions as a result of longer graft and patient survival and the likelihood of achieving a reasonably good quality of life for patients of all ages. Studies are warranted to understand if quality of life might serve as a moderating variable to balance question of age and transplant allocations. OBJECTIVE: To determine if there are differences in the pretransplant and posttransplant quality of life of kidney transplant recipients with respect to age. DESIGN, PARTICIPANTS, SETTING, AND OUTCOME MEASURES: This study comparatively examined the differences in pretransplant and posttransplant quality of life of kidney transplant recipients in 5 age groups (18-29 years, 30-39, 40-49, 50-59, and older than 60). A sample of 293 patients admitted to a midsouthern US transplant center and selected on a convenience-sampling basis were included in the study. Multiple measures of quality of life were used, including the Quality of Life Index, the Adult Self-Image Scale, and the Sickness Impact Profile. RESULTS: Both the pretransplant and posttransplant quality of life of all age groups of kidney transplant recipients were similar, with the exception that the recipients in the age range of 30 to 49 years reported better posttransplant quality of life on the Sickness Impact Profile Psychosocial measure (F=2.18, P=.02). CONCLUSIONS: Quality of life outcomes do not appear to favor one age group over another, although psychosocial outcomes may warrant some additional consideration.