Implementing a self‐reported immunosuppression adherence questionnaire to screen for non‐adherence in routine care of kidney transplant recipients

Abstract

AbstractIntroductionSelf‐reported measures of immunosuppression adherence have been largely examined in research settings.MethodsIn this single center study of 610 kidney transplant recipients, we examined if a voluntary, non‐anonymous self‐report measure could identify non‐adherence in a routine clinic setting and how patients perceived such a measure. Non‐adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) and patient perception was elicited using a customized questionnaire.ResultsNon‐responders to the survey (15%) were younger, more likely to be black, and less likely to have had a pre‐emptive transplant. Among complete responders (n = 485), 38% reported non‐adherence with non‐adherent patients being younger (54 y vs. 60 y; p = .01), less likely to have been on dialysis pre‐transplant (59% vs. 68%; p = .04), further out from transplant (37 vs. 22 months; p < .001) and had more rejections in the preceding year (8% vs. 3%; p = .02). Self‐reported non‐adherence was associated with higher calcineurin inhibitor intra‐patient variability (27.4% vs. 24.5%; p = .02), but not with donor‐specific antibody detection (27.8% vs. 21.2%, p = .15). Of patients providing feedback (n = 500), the majority of patients felt comfortable reporting adherence (92%), that the survey was relevant to their visit (71%), and that the survey did not interfere with their clinic visit (88%).ConclusionIn summary, a self‐reported questionnaire during clinic visits identified immunosuppression non‐adherence in a significant proportion of patients and was well received by patients. Integrating self‐report measures into routine post‐transplant care may enable early identification of non‐adherence.