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Immunosuppressive therapy after solid-organ transplantation: does the INTERMED identify patients at risk of poor adherence?
Michaud, Laurent; Ludwig, Gundula; Berney, Sylvie; Rodrigues, Stéphanie; Niquille, Anne; Santschi, Valérie; Favre, Anne-Sophie; Lange, Anne-Catherine; Michels, Annemieke A; Vrijens, Bernard; Bugnon, Olivier; Pilon, Nathalie; Pascual, Manuel; Venetz, Jean-Pierre.
Afiliação
  • Michaud, Laurent; University Hospital of Lausanne (CHUV). Psychiatric Liaison Service. Lausanne. Switzerland
  • Ludwig, Gundula; University Hospital of Lausanne (CHUV). Psychiatric Liaison Service. Lausanne. Switzerland
  • Berney, Sylvie; University Hospital of Lausanne (CHUV). General Psychiatry Service. Lausanne. Switzerland
  • Rodrigues, Stéphanie; University Hospital of Lausanne, (CHUV). Lausanne. Switzerland
  • Niquille, Anne; University of Lausanne. Department of Ambulatory Care & Community Medicine. Lausanne. Switzerland
  • Santschi, Valérie; University of Applied Sciences. La Source School of Nursing Sciences. Lausanne. Switzerland
  • Favre, Anne-Sophie; University of Lausanne. Department of Ambulatory Care & Community Medicine. Community Pharmacy. Lausanne. Switzerland
  • Lange, Anne-Catherine; Westrock Healthcare. Visé. Belgium
  • Michels, Annemieke A; University of Lausanne. Department of Ambulatory Care & Community Medicine. Community Pharmacy. Lausanne. Switzerland
  • Vrijens, Bernard; University of Liège. Visé. Belgium
  • Bugnon, Olivier; University of Geneva. School of pharmaceutical sciences. Lausanne. Switzerland
  • Pilon, Nathalie; University Hospital of Lausanne (CHUV). Transplantation Centre. Lausanne. Switzerland
  • Pascual, Manuel; University Hospital of Lausanne (CHUV). Transplantation Centre. Lausanne. Switzerland
  • Venetz, Jean-Pierre; University Hospital of Lausanne (CHUV). Transplantation Centre. Lausanne. Switzerland
Pharm. pract. (Granada, Internet) ; 14(4): 0-0, oct.-dic. 2016. tab, graf
Artigo em Inglês | IBECS | ID: ibc-158877
Biblioteca responsável: ES1.1
Localização: BNCS
ABSTRACT

Background:

Lack of adherence to medication is a trigger of graft rejection in solid-organ transplant (SOT) recipients.

Objective:

This exploratory study aimed to assess whether a biopsychosocial evaluation using the INTERMED instrument before transplantation could identify SOT recipients at risk of suboptimal post-transplantation adherence to immunosuppressant drugs. We hypothesized that complex patients (INTERMED>20) might have lower medication adherence than noncomplex patients (INTERMED≤20).

Methods:

Each patient eligible for transplantation at the University Hospital of Lausanne, Switzerland, has to undergo a pre-transplantation psychiatric evaluation. In this context the patient was asked to participate in our study. The INTERMED was completed pre-transplantation, and adherence to immunosuppressive medication was monitored post-transplantation by electronic monitors for 12 months. The main outcome measure was the implementation and persistence to two calcineurin inhibitors, cyclosporine and tacrolimus, according to the dichotomized INTERMED score (>20 or ≤20).

Results:

Among the 50 SOT recipients who completed the INTERMED, 32 entered the study. The complex (N=11) and noncomplex patients (N=21) were similar in terms of age, sex and transplanted organ. Implementation was 94.2% in noncomplex patients versus 87.8% in complex patients (non-significant p-value). Five patients were lost to follow-up one was non-persistent, and four refused electronic monitoring. Of the four patients who refused monitoring, two were complex and withdrew early, and two were noncomplex and withdrew later in the study.

Conclusion:

Patients identified as complex pre-transplant by the INTERMED tended to deviate from their immunosuppressant regimen, but the findings were not statistically significant. Larger studies are needed to evaluate this association further, as well as the appropriateness of using a nonspecific biopsychosocial instrument such as INTERMED in highly morbid patients who have complex social and psychological characteristics (AU)
RESUMEN
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Assuntos

Texto completo: Disponível Coleções: Bases de dados nacionais / Espanha Base de dados: IBECS Assunto principal: Equipe de Assistência ao Paciente / Adaptação Psicológica / Transplante de Órgãos / Terapia de Imunossupressão / Adesão à Medicação Tipo de estudo: Estudo de etiologia / Estudo prognóstico / Fatores de risco Limite: Feminino / Humanos / Masculino País/Região como assunto: Europa Idioma: Inglês Revista: Pharm. pract. (Granada, Internet) Ano de publicação: 2016 Tipo de documento: Artigo Instituição/País de afiliação: University Hospital of Lausanne (CHUV)/Switzerland / University Hospital of Lausanne, (CHUV)/Switzerland / University of Applied Sciences/Switzerland / University of Geneva/Switzerland / University of Lausanne/Switzerland / University of Liège/Belgium / Westrock Healthcare/Belgium

Texto completo: Disponível Coleções: Bases de dados nacionais / Espanha Base de dados: IBECS Assunto principal: Equipe de Assistência ao Paciente / Adaptação Psicológica / Transplante de Órgãos / Terapia de Imunossupressão / Adesão à Medicação Tipo de estudo: Estudo de etiologia / Estudo prognóstico / Fatores de risco Limite: Feminino / Humanos / Masculino País/Região como assunto: Europa Idioma: Inglês Revista: Pharm. pract. (Granada, Internet) Ano de publicação: 2016 Tipo de documento: Artigo Instituição/País de afiliação: University Hospital of Lausanne (CHUV)/Switzerland / University Hospital of Lausanne, (CHUV)/Switzerland / University of Applied Sciences/Switzerland / University of Geneva/Switzerland / University of Lausanne/Switzerland / University of Liège/Belgium / Westrock Healthcare/Belgium
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