Medication trade-offs significantly associated with readmissions after liver transplant

WASHINGTON — A brief, routine assessment of financial barriers and certain other potential signifiers may result in fewer hospital readmissions for patients after liver transplantation, according to a presenter at The Liver Meeting.

“One in six liver transplant recipients is making trade-offs,” Marina Serper, MD, MS,of the division of gastroenterology and hepatology at Northwestern University, said during her presentation. These trade-offs include putting off prescription medications in order to buy food and spacing out how frequently medicine is taken because more medicine could not be afforded.

Those at higher risk for trade-offs include patients with lower incomes, limited literacy, higher number of medications and high comorbidity.

Researchers performed a cross-sectional study of 105 liver transplant recipients (mean age, 57 years; 59% male; 81% non-Hispanic white) at two centers during 2011 and 2012. Twenty-five percent of recipients did not complete high school, and 16% had incomes less than $20,000 annually. Median time since transplantation was 20 months and the average number of medications taken was 11.

Bivariate analysis demonstrated race, insurance type, income, health literacy and education were each associated with medication trade-offs (all P<.05). Multivariate analysis found lower income and limited literacy remained independently associated with medication trade-offs (P<.05). Medication trade-offs also were independently associated with the number of hospital readmissions in multivariate analysis (incidence RR=2; 95% CI, 1.1-3.7), but self-reported nonadherence was not.

The study also determined that 25% of patients were unaware of medication indications, and 42% were unable to demonstrate proper dosing of their medications.

“Financial considerations are important in post-transplant adherence,” Serper said. “A brief, routine assessment of financial barriers may be warranted.

“As transplant centers, we should think about multifaceted, prospective trials looking at interventions to improve adherence through additional potential patient and caregiver education.”

Disclosure: Serper reports no relevant financial disclosures.

For more information:

Serper M. #5: Medication Tradeoffs, Nonadherence, and Clinical Outcomes Among Liver Transplant Recipients. Presented at: The Liver Meeting 2013; Nov. 1-5, Washington.