Michael O Killian, Callie W Little, Savarra K Howry, Madison Watkivs, Kelli N Triplett, Dev M Desai
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引用次数: 0
摘要
很少有儿科实体器官移植研究对免疫抑制药物的长期不依从性及其与人口统计学因素和移植后结果(包括晚期急性排斥反应和住院治疗)之间的关系进行研究。我们研究了小儿肾脏、肝脏和心脏移植受者患者用药水平变异指数(MLVI)依从性数据的纵向变化。器官共享联合网络(United Network for Organ Sharing)的患者和管理数据与 332 名患者的电子健康记录和 MLVI 值相关联。多层次中介模型显示,在移植后的 10 年中,纵向来看,患者之间的 MLVI 值差异要大于患者内部的差异。MLVI 值可明显预测晚期急性排斥反应和住院治疗。MLVI对患者因素和患者年龄的移植后结果具有部分中介作用,表明青少年可能从干预工作中获益最多。研究结果表明,对患者的用药依从性和差异进行纵向评估非常重要。促进患者坚持用药的努力应适用于高风险患者,以提高坚持用药的可能性。
Demographic Factors, Medication Adherence, and Post-transplant Health Outcomes: A Longitudinal Multilevel Modeling Approach.
Few studies in pediatric solid organ transplantation have examined non-adherence to immunosuppressive medication over time and its associations with demographic factors and post-transplant outcomes including late acute rejection and hospitalizations. We examined longitudinal variation in patient Medication Level Variability Index (MLVI) adherence data from pediatric kidney, liver, and heart transplant recipients. Patient and administrative data from the United Network for Organ Sharing were linked with electronic health records and MLVI values for 332 patients. Multilevel mediation modeling indicated comparatively more variation in MLVI values between patients than within patients, longitudinally, over 10 years post transplant. MLVI values significantly predicted late acute rejection and hospitalization. MLVI partially mediated patient factors and post-transplant outcomes for patient age indicating adolescents may benefit most from intervention efforts. Results demonstrate the importance of longitudinal assessment of adherence and differences among patients. Efforts to promote medication adherence should be adapted to high-risk patients to increase likelihood of adherence.
期刊介绍:
Journal of Clinical Psychology in Medical Settings is an international forum for the publication of peer-reviewed original papers related to all areas of the science and practice of psychologists in medical settings. Manuscripts are chosen that have a broad appeal across psychology as well as other health care disciplines, reflecting varying backgrounds, interests, and specializations. The journal publishes original research, treatment outcome trials, meta-analyses, literature reviews, conceptual papers, brief scientific reports, and scholarly case studies. Papers accepted address clinical matters in medical settings; integrated care; health disparities; education and training of the future psychology workforce; interdisciplinary collaboration, training, and professionalism; licensing, credentialing, and privileging in hospital practice; research and practice ethics; professional development of psychologists in academic health centers; professional practice matters in medical settings; and cultural, economic, political, regulatory, and systems factors in health care. In summary, the journal provides a forum for papers predicted to have significant theoretical or practical importance for the application of psychology in medical settings.