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

Abstract

Self-reported measures of immunosuppression adherence have been largely examined in research settings. In 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. Non-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 (54y vs. 60y; p=.01), less likely to have been on dialysis pre-transplant (59%vs. 68%; p=.04), further out from transplant (37vs. 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%). In 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.