Roberta Lopes Karlburger, João Henrique Sendrete de Pinho, Fernando Antônio Basile Colugnati, Kris Denhaerynck, José Osmar Pestana Medina, Tainá Veras de Sandes-Freitas, Sabina De Geest, Helady Sanders-Pinheiro, the ADHERE BRAZIL Study Team
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引用次数: 0
摘要
理由：肾移植（KT）后不遵守常规门诊预约（NApp）是一种与不良结果相关的健康行为，研究很少。在粘附巴西研究中，我们之前报道了这种行为的高患病率（12.7%）。目的和目的：本研究旨在确定与KT后NApp相关的多水平因素。方法：横断面研究，坚持巴西研究的子项目，进行。我们研究了来自20个移植中心的1105名患者的随机和多阶段样本。错过了最近五次预约中的一次或多次的患者被认为是不依从的。采用顺序逻辑回归进行多变量分析，根据生态模型（患者、微观、中观和宏观水平）评估49个多水平变量。结果：患者以男性为主（58.5%），平均年龄47.6±12.6岁。在患者水平上，与NApp相关的独立因素有：年龄（OR 0.97; 95% CI 0.96-0.99; p = 0.001）、KT后5年以上（OR 2.03; 95% CI 1.38-3.00; p）。结论：本研究首次探讨了卫生系统因素与KT后错过预约的关系。确定的患者因素使我们能够识别有NApp风险的患者。卫生专业人员和KT中心级别的可修改变量建议了旨在减少这种行为和改善结果的有效干预目标。试验注册：ClinicalTrials.gov， 2013年10月10日，编号：NCT02066935。
Associated Factors to Nonadherence to Routine Appointments after Kidney Transplantation: The ADHERE Brazil Study
Rationale
Nonadherence to routine outpatient appointments (NApp) post kidney transplantation (KT) is a poorly studied health behavior associated with unfavorable outcomes. In the ADHERE BRAZIL Study, we previously reported a high prevalence of this behavior (12.7%).
Aims and Objective
This study aimed to identify the multilevel factors associated with NApp after KT.
Method
A cross-sectional study, subproject of the ADHERE BRAZIL Study, was performed. We studied a randomized and multi-stage sample of 1105 patients from 20 transplant centers. Patients who missed one or more of the last five scheduled appointments were considered nonadherent. Multivariate analysis was performed using sequential logistic regression, evaluating 49 multilevel variables, according to the Ecological Model (patient, micro, meso, and macro levels).
Results
Most patients were male (58.5%), with a mean age of 47.6 ± 12.6 years. The independent factors associated with NApp were, at the patient level: age (OR 0.97; 95% CI 0.96–0.99; p = 0.001), more than 5 years after KT (OR 2.03; 95% CI 1.38–3.00; p < 0.001), and nonadherence to immunosuppressives (OR 2.41; 95% CI 1.66–3.50; p < 0.001); at the micro level (health professionals): higher scores on the team trust scale (0–100) (OR 0.98; 95% CI 0.95–1.00; p < 0.079), and at the meso level (KT center): frequent (monthly) consultations (OR 1.75; 95% CI 1.10–2.77; p < 0.018) and scheduling difficulties (OR 1.91; 95% CI 1.16–3.17; p < 0.011).
Conclusion
This study is the first to examine the association of health system factors with missed appointments after KT. The identified patient factors allow us to recognize patients at risk for NApp. Modifiable variables at the health professional and KT center levels suggest targets for effective interventions aiming to reduce this behavior and improve outcomes.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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