抄録
【Objective】Although the reported incidence of medication non-adherence after pediatric liver transplantation (LT) is from 5.6% to 65.0%, and the reported incidence of graft failure due to medication nonadherence is 17.0%, the current state of medication non-adherence in Japan is unclear. In this study, we sought to clarify the current state of medication non-adherence in our institution and investigated measures to prevent medication nonadherence.
【Design】From June 1998 to February 2013, a total of 125 LTs were performed in our institution and others. All patients were beyond the age of junior high school students (geq 12 years old). The investigation period was January 2014 to January 2015.
【Methods】Data regarding the frequency of medication nonadherence and medication management were retrospectively collected based on the medical records by the attending physicians. The patients were classified in two groups, namely, the good-medication adherence group and the medication nonadherence group, and risk factors for medication nonadherence and factors related to medication management were evaluated. The rate of medication nonadherence was clarified by age at this investigation and at LT.
【Results】Medication nonadherence was observed in 42 cases (33.6%). The ages at this investigation and at LT were significantly higher in the medication nonadherence group than in the good-medication adherence group (p=0.05 and p＜0.01, respectively). The graft function was significantly worse in the medication nonadherence group than in the good-medication adherence group (p＜0.01), and more patients had graft failure (three (8.1%) vs. one (1.2%), respectively, p=0.12). In the 40 patients who received treatment with three types of immunosuppressants, the age at the start of medication tended to be higher in the medication nonadherence group than in the good-medication adherence group (p=0.11), and all patients with medication nonadherence had a graft dysfunction. With respect to social factors, the number of patients with ambulatory irregularities, and those, exhibiting medication self-management, changes in the home environment, and unpleasant experiences of medication were significantly higher in the medication nonadherence group than in the good-medication adherence group (p＜0.01, p＜0.01, p＜0.01, and p＜0.01, respectively).
【Conclusions】It is important to provide personal and continuous patient compliance instructions to patients shifting to medication self-management, such as patients beyond the age of junior high school students. It is necessary for self-managed patients to adhere to the patient compliance instructions, especially when immunosuppressant therapy is intensified. When the patient's family background or life situation changes, additional patient compliance instructions should therefore be provided despite the patient's age.
