Facilitators and barriers of medication adherence in pediatric liver and kidney transplant recipients: a mixed-methods study

Objective-Many young transplant patients (<= 11 years old) struggle to take their immunosuppressive and co-medications correctly, yet it remains unclear which factors positively or negatively affect medication adherence. Research studies on determinants in this age group are scarce, have methodological flaws, and focus exclusively on immunosuppressants or on barriers rather than on facilitators. Methods-This study used a consecutive mixed-methods (qualitative + quantitative) design. Semistructured interviews with parents of 10 pediatric liver or kidney transplant recipients 2 to 11 years old on adherence facilitators and bathers were conducted, complemented by quantification of adherence to the immunosuppressants and co-medications, and completion of the "immunosuppressive medication adherence barriers" self-report instrument. Results-A median of 19 (range, 10-29) barriers was reported: the most commonly encountered were forgetfulness (70%), vomiting (70%), bad taste (60%), and interruptions in routine (60%). Parents reported a median of 15 facilitators (range, 6-26), including using practical aids (100%), having medication with you at all times (100%), having to take fewer medications (80%), and experiencing fewer regimen changes over time (80%). No clear distinction between immunosuppressants or co-medications was made. Conclusions-This study provides several new insights based on peer experience to support future patients and their parents in medication adherence. (C)2014 NATCO, The Organization for Transplant Professionals