Review analyzing the effectiveness of interventions to promote medication adherence in patients after solid organ transplantation
Abstract
Introduction and objective: Non-adherence to immunosuppressive therapy may lead to graft rejection in transplanted patients. The aim of this study was to evaluate the effectiveness of interventions to promote adherence to immunosuppressives in patients after transplantation of kidney, heart, liver, lung, or combination of the above mentioned organs in previously published secondary literature reviews.
Methods: PubMed, Embase and Cochrane Database of Systematic Review were searched using the following search terms: "adherence", or "compliance", "transplant*" and "interven*". The systematic reviews published until June, 2018 were analyzed.
Quality of them was evaluated by AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Results: Seven studies were included with a total of 46 primary studies.
Reduced risk of developing graft rejection in patients receiving the intervention was found in 3 studies. Positive effect of interventions on the improvement of adherence to immunosuppressives or change in other behavioral aspects of the treatment, such as health literacy or quality of life, was found in 24 studies.
The most effective strategy was to use multimodal interventions focused on multiple risk factors of non-adherence. Except of one review, the quality according to AMSTAR 2 tool was low or very low.
Conclusion: Although the effectiveness of interventions to increase adherence has not been established, in the clinical practice, various interventions may have a positive effect on adherence, particularly based on individualized approach to each patient. However, additional robust, controlled studies are needed to verify the effectiveness of this procedure.