Measuring compliance with drug regimens after renal transplantation: comparison of self-report and clinician rating with electronic monitoring

Butler, Janet A.1 5; Peveler, Robert C.1; Roderick, Paul2; Horne, Robert3; Mason, Juan C.4

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Nonadherence to immunosuppressants in renal transplant recipients is a major factor affecting graft survival, but it is difficult to detect accurately in clinical practice. Adherence was measured in 153 adult renal transplant recipients using self-report questionnaires and interview, clinician rating, and cyclosporine levels. The sensitivity and specificity of these measures were determined by comparison with electronic monitoring in a randomly selected subsample of 58 subjects. Measures of adherence in current clinical use do not perform well when tested against electronic monitoring. Self-report at a confidential interview was the best measure of adherence for the detection of both missed doses and erratic timing of medication. However, the use of a confidential interview is not directly applicable to a clinical setting. Further research on how best to facilitate disclosure in clinical settings may be the best way to develop adherence measures for use in routine practice.

1 University Mental Health Group, Royal South Hants Hospital, Southampton, United Kingdom.

2 University Healthcare Research Unit, Southampton General Hospital, Southampton, United Kingdom.

3 Centre for Health Care Research, University of Brighton, Falmer, Brighton.

4 Wessex Renal Unit, Queen Alexandra Hospital, Portsmouth, United Kingdom.

Funded by the Medical Research Council as part of a Clinical Research Training Fellowship for Janet Butler, Ph.D.

5 Address correspondence to: Janet A. Butler, Ph.D., University Mental Health Group, Royal South Hants Hospital, Brintons Terrace, Southampton SO14 0YG, United Kingdom.

Received 13 May 2003.

Revised 29 July 2003.

Accepted 12 August 2003.

© 2004 Lippincott Williams & Wilkins, Inc.