Medication nonadherence monitoring and management in adult kidney transplantation: A survey of practices and perceptions at US-based transplant programs

Introduction: Medication nonadherence is a predominant contributor to graft loss, however little is known about currently utilized strategies by transplant centers to monitor or manage this issue. Objective: Utilizing standard surveying and analysis techniques, assess health care professionals' (HCPs) perceptions of the scope and scale of medication nonadherence and strategies used to manage this issue at US-based transplant centers. Methods: A survey to gain insights into pre- and post-transplant medication nonadherence screening, mitigation strategies and perceptions of HCPs regarding nonadherence was developed through an iterative process. This was followed by broad distribution to HCPs at US-based adult kidney transplant centers. Standard descriptive and comparative statistics were utilized to assess responses and develop inferences and themes from participant responses. Results: One hundred and ninety HCPs from 99 centers responded; 56.5% felt medication nonadherence was a major contributor to post-transplant rejection and graft loss, while 71.1% acknowledged not having a prospective medication nonadherence screening protocol. Of those centers with a protocol, screening declined over time (first post-transplant month: 92.7%; after 1-year: <50%). Medication nonadherence management strategies also declined over time (initial transplant stay: 76%; after 1-year: 6.5%). Few HCPs (24.1%) felt their centers had adequate resources to implement management strategies. Barriers to implement strategies included large patient volume (68.2%) and lack of a validated, easy to use, noninvasive medication nonadherence measure (65.9%). Conclusion: While HCPs at US-based adult kidney transplant programs feel that medication nonadherence is a significant issue, the use of systematic processes aimed at prospectively identifying and addressing medication nonadherence is uncommon. Opportunities exist to better address medication nonadherence in kidney transplantation, using feasible noninvasive monitoring and management strategies that align with current HCPs workflow and logistic constraints.