The prevalence, risk factors, and outcomes of medication trade ‐offs in kidney and liver transplant recipients: a pilot study

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). Asses...
Source: Transplant International - Category: Transplant Surgery Authors: Tags: Original Article Source Type: research