Abstract
Non-adherence to medical treatment has emerged as a significant problem in transplantation (tx) and has particularly been associated with adolescence. There is little research on the risk factors for non-adherence in heart and heart-lung transplant patients but it has been suggested that up to a third of patients are non-adherent to some aspects of the treatment regimen. Fifty adolescents and young adults (24 males, 26 females; mean age: 17.9 years, range 12.3-24.9 years) who had undergone heart (n=42) or heart-lung (n=8) tx 1.4-14.9 years (mean 8.8 years) previously were asked to complete the Beliefs about Medication Questionnaire (BMQ), Perceived Illness Experience (PIE) scale and a demographics questionnaire. The notes of all patients were reviewed for information regarding previous psychiatric referral, rejection episodes and complications and noted concerns about adherence. Forty completed questionnaires were received and in 11 (28%) non-adherence to treatment was reported. It was also documented in the clinical notes of 9 (18%) of the patients. Non-adherence recorded in the notes was classified as intentional non-adherence and was correlated with lack of exercise (p=.032), psychiatric referral (p=.009) and lymphoma (p=.009). Non-adherence determined from the questionnaires was classified as unintentional and related to forgetting to take medication. Unintentional non-adherence was correlated with high scores on the preoccupation with illness (p=.041) and difficulties at school (p=.009) subscales of the PIE. In conclusion, more than a quarter of the sample demonstrated non-adherence to the treatment regimen. In contrast to previous research, we found that unintentional non-adherence is associated with different factors to intentional non-adherence. Future research is required to determine whether unintentional non-adherence results in significant medical complications in the longer term and how a reduction in the prevalence of non-adherence can be facilitated.
Published Version
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