Kris Denhaerynck|Lut Berben|Fabienne Dobbels|Cynthia L. Russell|María G. Crespo?Leiro|Alain Poncelet|Sabina De Geest
Multilevel factors are associated with immunosuppressant nonadherence in heart transplant recipients: The international BRIGHT study
University of Basel|University of Basel|University of Basel|KU Leuven|University of Missouri–Kansas City|Complexo Hospitalario Universitario A Coruña|Centro de Investigación Biomédica en Red|Instituto de Investigación Biomédica de A Coruña|Cliniques Universitaires Saint-Luc|University of Basel|KU Leuven
factors level familyhealthcare worker organization system neglected medication nonadherence research heart transplantation htx 4continent 11country crosssectional building research initiative group chronic illness management adherence transplantation bright study used multistaged sampling examine 36 htx centers including 36 htx directors 100 clinicians 1397 patients nonadherence immunosuppressantsdefined deviation taking timing adherence andor dose reductionwas assessed using basel assessment adherence immunosuppressive medications scale baasis interview guided integrative model behavioral prediction bronfenbrenners ecological model analyzed factors multiple levels using sequential logistic regression analysis 6 blocks nonadherence prevalence 341 six multilevel factors associated independently either positively negatively nonadherence patient level barriers taking immunosuppressants odds ratio 1148 smoking 219 familyhealthcare provider level frequency someone help patients read healthrelated materials 085 organization level clinicians reporting nonadherent patients targeted adherence interventions 066 pickup medications physicians office 231 policy level monthly outofpocket costs medication 116 factors associated nonadherence evident multiple levels improving medication nonadherence requires addressing patient also familyhealthcare provider organization policy levels