Health literacy level in a various nephrology population from Québec: predialysis clinic, in-centre hemodialysis and home dialysis; a transversal monocentric observational study.

BACKGROUND: Health literacy refers to the ability of individuals to gain access to, use, and understand health information and services in order to maintain a good health. It is especially important in nephrology due to the complexity of chronic kidney disease (CKD). The present study sought to define health literacy levels in patients followed in predialysis clinic, in-center dialysis (ICHD), peritoneal dialysis (PD) and home hemodialysis (HHD). METHODS: This transversal monocentric observational study analysed 363 patients between October 2016 and April 2017. The Brief Health Literacy Screen (BHLS) and the Health Literacy Questionnaire (HLQ) were used to measure health literacy. Multivariate linear regressions were used to compare the mean scores on the BHLS and HLQ, across the four groups. RESULTS: Patients on PD had a significantly higher BHLS'score than patients on ICHD (p = 0.04). HLQ's scores differed across the groups: patients on HHD (p = 0.01) and PD (p = 0.002) were more likely to feel understood by their healthcare providers. Compared to ICHD, patients on HHD were more likely to have sufficient information to manage their health (p = 0.02), and patients in the predialysis clinic were more likely to report high abilities for health information appraisal (p < 0.001). CONCLUSION: In a monocentric study, there is a significant proportion of CKD patients, especially in predialysis clinic and in-centre hemodialysis, with limited health literacy. Patients on home dialysis (HHD and PD) had a higher level of health literacy compared to the other groups.

Negative affect and self-agency's association with immunosuppressant adherence in organ transplant: A meta-analysis.

Objective: In organ transplant, prevalence estimates of negative affect (e.g., depressive symptoms) are higher than in the general population and self-agency is required for successful regimen self-management. Nonetheless, the roles of these psychological factors for immunosuppressant adherence in this population remain unclear. Method: Meta-analytic techniques were used to determine the associations between negative affect and self-agency with adherence and to identify moderators of these associational effect sizes (ES). Results: Across 50 studies and 46,106 adult organ recipients, there is a small negative association between negative affect and adherence (mean weighted ES: r = -.14, p < .001; 95% confidence interval, CI [-.175, -.096]) and a small positive association between self-agency and adherence (ES: r = .17, p < .001; 95% CI [.094, .251]). Studies conducted outside of Europe and North America, assessing illness-specific negative affect and utilizing questionnaire adherence measures, and studies of better quality were associated with a larger ES, explaining 54% of the heterogeneity in the negative affect and adherence association. For the association between self-agency and adherence, a higher percentage of females and medication-specific self-agency were associated with a larger ES, explaining 34% of the heterogeneity. Conclusions: By elucidating overlooked trends in the existing literature for the associations between negative affect and self-agency with adherence, the current meta-analyses clarify previously contradicting findings in organ transplant. The findings also shed light on factors contributing to the existing variability and highlight the importance of careful consideration of methodology in studies of adherence postorgan transplant. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Impact of Once- Versus Twice-Daily Tacrolimus Dosing on Medication Adherence in Stable Renal Transplant Recipients: A Canadian Single-Center Randomized Controlled Trial.

BACKGROUND: Prevalence of immunosuppressant nonadherence in renal transplant recipients is high despite negative clinical outcomes associated with nonadherence. Simplification of dosing has been demonstrated to improve adherence in renal transplant recipients as measured through electronic monitoring and self-report. OBJECTIVE: The purpose of this study was to replicate and extend previous findings by measuring adherence with multiple methods in a Canadian sample. DESIGN: The study design was a randomized controlled medication dosing trial in adult renal transplant patients. The trial length was 4 months. SETTING: This study was conducted within the Solid Organ Transplant (SOT) Clinic at Vancouver General Hospital (VGH; Vancouver, Canada). PATIENTS: A total of 46 adult renal recipients (at least 1 year post-transplant) were recruited through the SOT clinic. With 8 withdrawals, 38 individuals completed all phases of the study. MEASUREMENTS: Medication adherence was measured for a period of 4 months using multiple methods, including electronic monitoring (MEMS [Medication Event Monitoring System]), pharmacy refill data (medication possession ratio [MPR]), and by self-report using the Adherence subscale of the Transplant Effects Questionnaire (TEQ). METHODS: Participants were randomized to twice-daily (n = 19) or once-daily tacrolimus dosing (n = 19) and followed over a 4-month period via monthly clinic study visits. Comparisons between the treatment groups were performed using the Mann-Whitney U and chi-square tests, for continuous and categorical variables, respectively. RESULTS: As outlined in Table 3, the once-daily dosing group showed significantly better MEMS Dose Adherence (P = .001), whereas MEMS Timing Adherence showed a tendency toward better adherence for this group, but was not significant (P = .052). MEMS Days Adherent (P = .418), MPR% (P = .123), and self-reported adherence (P = .284) did not differ between the once- and twice-daily dosing groups when measured as continuous variables. The MPR% was significantly better for the once-daily dosing group when measured dichotomously but not continuously (P = .044). Notably, most of those exposed to once-daily dosing (63.2%) preferred this to the twice-daily regimen. LIMITATIONS: Limitations included small sample size and short follow-up period, precluding the examination of clinical outcome differences. CONCLUSIONS: Results for dose adherence replicate the finding that dose simplification increases adherence to immunosuppressants as measured through electronic monitoring. Such an advantage for the once-daily dosing group was not seen across the 2 other electronic monitoring measurement variables (days and timing adherence). This study extends previous research by examining adherence in once versus twice-daily dosing via prescription refill data in a Canadian sample. Given the gravity of potential health outcomes associated with nonadherence, although results indicate inconsistencies in significance testing across measurement methods, the medium to large effect sizes seen in the data favoring better adherence with once-daily dosing provide an indication of the potential clinical significance of these findings. TRIAL REGISTRATION: This study was registered with ClinicalTrials.gov (NCT01334333) on April 11, 2011.

CONTEXTE: Bien que la non-observance du traitement immunosuppresseur soit associée à de mauvais résultats cliniques, sa prévalence demeure élevée chez les receveurs d'une greffe rénale. Il a été démontré qu'une posologie simplifiée améliorait l'observance thérapeutique mesurée par suivi électronique et auto-évaluation dans cette population. OBJECTIF: Cette étude visait à reproduire et à élargir les résultats d'études précédentes en mesurant par différentes méthodes l'observance thérapeutique dans un échantillon de patients canadiens. TYPE D'ÉTUDE: Un essai contrôlé à répartition aléatoire d'une durée de quatre mois examinant la posologie médicamenteuse d'adultes greffés rénaux. CADRE: L'étude s'est tenue au sein de la Solid Organ Transplant Clinic (clinique SOT) du Vancouver General Hospital (VGH; Vancouver, Canada). SUJETS: Quarante-six greffés rénaux adultes ont été recrutés (au moins un an post-transplantation) par l'entremise de la clinique SOT. En raison de huit retraits, l'étude porte sur trente-huit individus ayant complété toutes les phases de l'étude. MESURES: L'observance thérapeutique a été mesurée sur une période de quatre mois, selon différentes méthodes, notamment le suivi électronique (MEMS), le renouvellement des ordonnances (rapport de possession de médicaments­RPM) et l'auto-évaluation avec la sous-échelle d'observance du Transplant Effects Questionnaire (TEQ). MÉTHODOLOGIE: Les participants ont été répartis aléatoirement pour recevoir du tacrolimus deux fois par jour (n = 19) ou une fois par jour (n = 19) et ont été suivis pendant quatre mois au moyen de visites mensuelles à la clinique. Les comparaisons entre les groupes de traitement ont été effectuées par tests U de Mann-Whitney (variables continues) et tests de chi-deux (variables nominales). RÉSULTATS: Comme indiqué dans le tableau 3, lorsque l'observance est mesurée par MEMS, le groupe ayant reçu une dose quotidienne unique a montré une observance nettement supérieure au niveau de la dose (P = 0.001), de même qu'une tendance vers une meilleure observance du traitement au niveau du moment, quoique cette dernière ne soit pas significative (P = 0.052). Le nombre de jours d'observance mesuré par MEMS (P = 0.418), le pourcentage RPM (P = 0.123) et l'observance auto-déclarée (P = 0.284) n'ont pas différé entre les groupes lorsque mesurés comme variables continues. Le pourcentage RPM était significativement plus élevé pour le groupe traité une fois par jour, lorsque mesuré de façon dichotomique, mais non continue (P = 0.044). La majorité des patients traités par une dose unique quotidienne (63.2%) ont préféré ce schéma posologique à une prise deux fois par jour. LIMITES: La petite taille de l'échantillon et la courte période de suivi empêchent l'examen des différences observées dans les résultats cliniques. CONCLUSION: Les résultats sur l'observance de la dose reproduisent la conclusion selon laquelle un dosage simplifié augmenterait l'observance du traitement immunosuppresseur, lorsque mesurée par MEMS. Un tel avantage pour le groupe recevant une dose quotidienne unique n'a pas été observé pour les deux autres variables de mesure par MEMS (observance en jours et du moment de la prise du médicament). La présente étude élargit les recherches antérieures en examinant l'observance de la posologie (une ou deux fois par jour) avec les données de renouvellement des ordonnances dans un échantillon canadien. Compte tenu de la gravité des effets potentiels de la non-observance thérapeutique sur la santé, et bien que les résultats indiquent des incohérences entre les méthodes de mesure dans la vérification des hypothèses, l'ampleur moyenne à grande de l'effet observé dans les données favorisant une meilleure observance à une dose unique quotidienne souligne l'importance clinique potentielle de ces résultats.

Opportunities for Engaging Patients in Kidney Research.

PURPOSE: The purpose of this review is to provide a summary of the rationale for engaging patients in research as well as to review the established and envisioned advantages and strategies for patient-researcher partnerships. The authors of this article, which include a patient and 4 researchers in kidney disease, discuss the expected benefits and opportunities for patient engagement in their respective research programs. The 4 research programs span the spectrum of kidney disease and focus on enhancing bone health, increasing living donor kidney transplants, improving medication adherence, and preventing kidney transplant rejection. SOURCES OF INFORMATION: The sources of information for this review include published studies on the topics of patient engagement and the 4 research programs of the new investigators. KEY FINDINGS: (1) Patient, health care provider, and researcher partnerships can contribute useful insights capable of enhancing research in kidney disease. (2) Regardless of the research program, there are various strategies and opportunities for engagement of patients with lived experience across the various stages of research in kidney disease. (3) Envisioned advantages of patient-researcher partnerships include: targeting patient-identified research priorities, integrating patients' experiential knowledge, improving study design and feasibility through patient-researcher input, facilitating dissemination of research findings to other patients, effectively responding to patient concerns about studies, and inspiring researchers to conduct their research. LIMITATIONS: The limitations of the current review include the relative scarcity of literature on patient engagement within the field of kidney disease. IMPLICATIONS: The findings of the current review suggest that it will be important for future studies to identify optimal strategies for patient engagement in setting research priorities, study design, participant recruitment, execution of research projects, and knowledge dissemination and translation.

OBJET: Le but de cet article synthèse est de fournir un résumé des raisons justifiant de faire participer les patients à la recherche. On veut également examiner les avantages établis et envisagés, de même que les stratégies de partenariats patients-chercheurs. Les auteurs de cet article, un patient et quatre chercheurs dans le domaine des maladies rénales, discutent des bénéfices espérés et des débouchés attendus de l'implication des patients dans leurs programmes de recherche respectifs. Les quatre programmes de recherche étudiés couvrent un spectre étendu dans le domaine des maladies du rein, et se concentrent sur l'amélioration de la santé osseuse, l'augmentation du nombre de greffes provenant de donneurs vivants, l'amélioration de l'observance à la médication et la prévention du rejet de la greffe. SOURCES: Les sources consultées comprennent les recherches publiées sur le thème de la participation des patients en recherche et sur les quatre programmes de recherche des chercheurs participants (amélioration de la santé osseuse, augmentation du nombre de greffes provenant de donneurs vivants, amélioration de l'observance à la médication et prévention du rejet de greffe). PRINCIPALES CONCLUSIONS: (1) Les partenariats entre les patients, les professionnels de la santé et les chercheurs peuvent apporter de précieuses informations susceptibles de faire avancer la recherche sur les maladies rénales. (2) Peu importe le programme de recherche, il existe plusieurs stratégies et possibilités pour encourager la participation de patients et le partage de leur expérience lors des différentes étapes de la recherche sur les maladies rénales. (3) On discute des nombreux avantages attendus des partenariats patients-chercheurs, notamment le ciblage des priorités de recherche établies par les patients, l'intégration des connaissances tirées de l'expérience des patients, l'amélioration de la conception et de la faisabilité des études par les apports des patients et des chercheurs, la diffusion facilitée des résultats de la recherche auprès des autres patients, la réponse efficace aux soucis des patients en regard des études, et la source de motivation fournie aux chercheurs pour la poursuite de leurs études. LIMITES DE L'ÉTUDE: Les résultats sont limités par le fait qu'il existe peu de recherches ayant porté sur la participation des patients à la recherche sur les maladies rénales. IMPLICATIONS: Les résultats de cette étude suggèrent qu'il sera important pour les études ultérieures de définir les stratégies optimales favorisant la participation des patients lors de l'établissement des priorités de recherche, de la conception de l'étude, du recrutement des participants, de l'exécution des projets de recherche et au moment de la diffusion et du transfert des connaissances.

An observational study of health literacy and medication adherence in adult kidney transplant recipients.

BACKGROUND: There is a high prevalence of non-adherence to immunosuppressants in kidney transplant recipients. Although limited health literacy is common in kidney recipients and is linked to adverse outcomes in other medical populations, its effect on medication adherence in kidney transplant recipients remains poorly understood. The objective was to investigate the effect of lower health literacy on immunosuppressant adherence. METHODS: Kidney recipients who were at least 6 months post-transplant and outpatients of Vancouver General Hospital in B.C., Canada were recruited through invitation letters. A total of 96 recipients completed the Health Literacy Questionnaire, which provides a multifactorial profile of self-reported health literacy and the Transplant Effects Questionnaire-Adherence subscale measuring self-reported immunosuppressant adherence. Hierarchical linear regression was used to analyze the association between health literacy and adherence after controlling for identified risk factors of non-adherence. RESULTS: Our sample was on average 53 years old, 56% male and 9 years post-transplant. Kidney recipients reported low levels of health literacy on scales measuring active health management and critical appraisal of information and 75% reported non-perfect adherence. Worse adherence was associated with poorer overall health literacy (ΔR2 = 0.08, P = 0.004) and lower scores on six of nine of the health literacy factors. CONCLUSIONS: Poorer health literacy is associated with lower immunosuppressant adherence in adult kidney transplant recipients suggesting the importance of considering a recipient's level of health literacy in research and clinical contexts. Medication adherence interventions can target the six factors of health literacy identified as being risk factors for lower medication adherence.