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Randomized Controlled Trial
. 2017;135(1):6-14.
doi: 10.1159/000448627. Epub 2016 Sep 7.

A Pilot Randomized Controlled Trial to Promote Immunosuppressant Adherence in Adult Kidney Transplant Recipients

Daniel Cukor  1 , Nisha Ver Halen, Melissa Pencille, Fasika Tedla, Moro Salifu
Affiliations
Randomized Controlled Trial

A Pilot Randomized Controlled Trial to Promote Immunosuppressant Adherence in Adult Kidney Transplant Recipients

Daniel Cukor et al. Nephron. 2017.

Abstract

Background: Nonadherence to immunosuppressant medication is a prevalent practice among kidney transplant recipients and has been associated with increased risk for graft failure and economic burden. The aim of this pilot study was to test whether a culturally sensitive cognitive-behavioral adherence promotion program could significantly improve medication adherence to tacrolimus prescription as measured by telephone pill counts among kidney transplant recipients.

Methods: Thirty-three adult transplant recipients were less than 98% adherent to tacrolimus prescription based on 3 telephone pill counts and were randomized either to the 2-session cognitive-behavioral adherence promotion program or to standard care. The curriculum was developed from an iterative process with transplant recipients into a 2-session group program that provided psychoeducation, addressed barriers to adherence, fostered motivation to improve adherence behavior, and discussed cultural messages on adherence behavior.

Results: The intervention group displayed significantly higher levels of adherence when compared to the control group (t = 2.2, p = 0.04) and. similarly, when the amount of change was compared between the groups, the intervention group showed more change than the control condition (F (22,1) = 12.005, p = 0.003). Tacrolimus trough concentration levels were used as a secondary measure of adherence and, while there were no significant between-group differences for mean trough concentration levels, the variability in the trough levels did significantly decrease over time indicating more consistent pill-taking behavior in the intervention group.

Conclusions: There is preliminary support for the pilot program as a successful intervention in helping patients with their immunosuppressant medication.

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Figures

Figure 1
Figure 1
Percent of sample endorsing as a substantive barrier
Figure 2
Figure 2
Participant Flow
See this image and copyright information in PMC

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