Associated Factors to Nonadherence to Routine Appointments after Kidney Transplantation: The ADHERE Brazil Study.

Area of Science:

• Transplantation medicine
• Health services research
• Patient adherence behaviors

Background:

• Nonadherence to routine outpatient appointments (NApp) post kidney transplantation (KT) is a significant health behavior with unfavorable outcomes.
• The ADHERE BRAZIL Study previously identified a high prevalence of NApp (12.7%) in kidney transplant recipients.
• Understanding multilevel factors influencing NApp is crucial for improving post-transplant care.

Purpose of the Study:

• To identify multilevel factors associated with nonadherence to routine outpatient appointments (NApp) after kidney transplantation (KT).
• To explore patient-level, health professional (micro), and transplant center (meso) influences on NApp.

Main Methods:

• A cross-sectional study involving a randomized, multi-stage sample of 1105 patients from 20 transplant centers.
• NApp defined as missing one or more of the last five scheduled appointments.
• Multivariate analysis using sequential logistic regression evaluated 49 multilevel variables based on the Ecological Model.

Main Results:

• Patient-level factors associated with NApp included younger age, being more than 5 years post-KT, and nonadherence to immunosuppressants.
• Micro-level factor: Higher team trust scores showed a trend towards reduced NApp (OR 0.98).
• Meso-level factors: Frequent (monthly) consultations and scheduling difficulties were associated with increased NApp.

Conclusions:

• This study is the first to link health system factors to missed appointments post-KT.
• Identified patient factors help recognize individuals at risk for NApp.
• Modifiable factors at the health professional and transplant center levels offer targets for interventions to reduce NApp and improve outcomes.