Open AccessThe prevalence, risk factors, and outcomes of medication trade‐offs in kidney and liver transplant recipients: a pilot study
Author(s) -
Serper Marina,
Reese Peter P.,
Patzer Rachel R.,
Levitsky Josh,
Wolf Michael S.
Publication year - 2018
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13098
Subject(s) - medicine , medical prescription , liver transplantation , transplantation , emergency medicine , intensive care medicine , pharmacology
Summary High out‐of‐pocket medication costs negatively impact adherence in transplantation. We evaluated the association of “medication trade‐offs”—defined as choosing to spend money on other expenses over medications—with medication nonadherence and transplant outcomes. From 2011 to 2012, we performed a prospective study of 201 transplanted recipients ( n = 103 liver, n = 98 kidney and) at two large US transplant centers. Structured interviews assessed socio‐demographics, medication adherence, and medication trade‐offs. Multivariable models assessing risk factors for medications trade‐offs and the association between medications trade‐offs and post‐transplant hospital admissions were performed. A total of 17% of patients reported medication trade‐offs; the most common trade‐offs were inability to afford a prescription in the past 12 months and making choices between prescriptions and food. In multivariable analysis, insurance type ( RR : 2.97, 95% CI : 1.19–7.40), limited health literacy ( RR : 2.64, 95% CI : 1.23–5.64), and ≥3 comorbid conditions ( RR : 2.48, 95% CI : 1.09–5.62; all P < 0.05) were associated with trade‐offs. Patients with trade‐offs were more likely to report nonadherence to medications (mean adherence: 77 ± 23% with trade‐offs vs. 89 ± 19% without trade‐offs, P < 0.01). The presence of medication trade‐offs was associated with post‐transplant hospital admissions ( RR 1.64, 95% CI 1.14–2.35, P < 0.01). Assessments of financial barriers are warranted in clinical practice to identify nonadherence and improve post‐transplant outcomes.