Interventions used by health care professionals to enhance medication adherence in transplant patients: a survey of current clinical practice

Context-Although medication nonadherence is associated with severe complications including graft rejection and loss, its prevalence remains high among organ transplant recipients. Still, little information exists on clinical use of interventions to improve medication adherence. Objective-To identify transplant health care professionals' methods of assessing medication adherence, classify the used interventions, and measure those interventions' perceived effectiveness. Design, Setting and Participants-A 46-item questionnaire on adherence assessment and interventions was distributed at the 2010 International Transplant Nurses Society symposium in Germany. Data were analyzed by using descriptive statistics. Results-Of 141 distributed questionnaires, 94 (67%) were returned. Respondents with no direct patient contact (9%, n=8) were excluded. The most frequently used assessment strategy was patient self-reporting (60%, n=52). On average, participants reported using 47% of the educational/cognitive, 44% of the counseling/behavioral, and 42% of the psychological/affective interventions listed. Training patients to self-administer medications and providing printed adherence information were the most frequently used interventions (79% each, n=68), followed by providing printed medication instructions (69%, n=59). Most respondents (90%, n = 77) reported combining interventions. The intervention perceived as most effective was medication self-administration training. Conclusion-Although available alternatives are demonstrably more effective for enhancing medication adherence, this sample relied more on educational interventions. (Progress in Transplantation. 2011;21:322-331)