Follow-Up Location, Patient Satisfaction, and Medication Adherence Among Kidney Transplant Recipients in Iraq: A Cross-Sectional Study

Background: Adherence to immunosuppressive medications is essential for long-term graft survival after kidney transplantation, and patient satisfaction is a related but underexplored outcome, particularly when transplant and follow-up care occur in different locations. This study assessed medication adherence and patient satisfaction among kidney transplant recipients (KTRs) at two public hospitals in Baghdad and examined whether outcomes varied by follow-up location. Methods: This cross-sectional study included adult KTRs attending outpatient pharmacies of two public hospitals in Baghdad, Iraq. Adherence was assessed using the validated Arabic Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS), and satisfaction was assessed using the validated Arabic Patient Satisfaction Questionnaire (PSQ-18). Satisfaction across follow-up locations was compared using Kruskal–Wallis tests with Holm’s correction, while factors associated with medication adherence were examined using univariable binary logistic regression Results: A total of 123 KTRs were included in this study, of whom 67.5% were classified as adherent to immunosuppressive medications. Patient satisfaction differed significantly across follow-up locations in terms of general satisfaction, technical quality, and financial aspects domains, with large effect sizes observed for technical quality (η² = 0.188) and financial aspects (η² = 0.139). Patients who followed up in other Iraqi provinces reported higher scores for general satisfaction and technical quality, while financial satisfaction was highest among patients receiving their follow-up in Baghdad's public healthcare facilities and lowest among those followed in Baghdad's private healthcare facilities. No sociodemographic, clinical, follow-up location, or satisfaction variable was significantly associated with adherence. Conclusion: Patient satisfaction varied across follow-up locations, particularly regarding technical quality and cost of care. These findings highlight the need for coordinated and patient-centered follow-up services. The determinants of medication adherence in this population remain unclear and warrant investigation in larger, multicenter samples.