A Randomized Trial of a Multicomponent Intervention to Promote Medication Adherence: The Teen Adherence in Kidney Transplant Effectiveness of Intervention Trial (TAKE-IT)

Foster, Bethany J.; Pai, Ahna L. H.; Zelikovsky, Nataliya; Amaral, Sandra; Bell, Lorraine; Dharnidharka, Vikas R.; Hébert, Diane; Holly, Crystal; Knauper, Baerbel; Matsell, Douglas G.; Phan, Véronique; Rogers, Rachel; Smith, Jodi M.; Zhao, Huaqing; Furth, Susan L.

doi:10.1053/j.ajkd.2017.12.012

Cited by 115 publications

(155 citation statements)

References 52 publications

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“…Inclusion of adherence data in a national quality registry can help identify high‐risk patients and open up for evaluating prospective intervention studies to improve adherence in specific populations in a proper way. Further studies should focus on implementation of adherence‐promoting interventions .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of tools for annual capture of adherence to immunosuppressive medications after renal transplantation - a single-centre open prospective trial

et al. 2019

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Summary Annual assessment of adherence would strengthen long‐term outcome assessments from registry data. The objective of this study was to evaluate tools suitable for annual routine capture of adherence data in renal transplant recipients. A single‐centre open prospective trial included 295 renal transplant recipients on tacrolimus. Two‐thirds of the patients were included 4 weeks post‐transplant, randomized 1:1 to intensive or single‐point adherence assessment in the early phase and 1‐year post‐transplant. One‐third were included 1‐year post‐transplant during a cross‐sectional investigation. Adherence was assessed using multiple methods: The “Basel Assessment of Adherence to Immunosuppressive Medication Scale” (BAASIS©) questionnaire was used to assess self‐reported adherence. The treating clinician scored patient′s adherence and tacrolimus trough‐concentration variability was calculated. In the analyses, the data from the different tools were dichotomized (adherent/nonadherent). The BAASIS© overall response rate was over 80%. Intensive BAASIS© assessment early after transplantation increased the chance of capturing a nonadherence event, but did not influence the 1‐year adherence prevalence. The adherence tools generally captured different populations. Combining the tools, the nonadherence prevalence at 1 year was 38%. The different tools identified to a large degree different patients as nonadherent. Combining these tools is feasible for annual capture of adherence status.

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Section: Discussionmentioning

confidence: 99%

Evaluation of tools for annual capture of adherence to immunosuppressive medications after renal transplantation - a single-centre open prospective trial

et al. 2019

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“…Other studies evaluating adherence-related interventions in AYAs with other chronic conditions have likewise used shorter baseline monitoring periods relative to the intervention. 25,26 Participants also completed weekly questionnaires addressing reasons for nonadherence.…”

Section: Designmentioning

confidence: 99%

Oral Medication Adherence Among Adolescents and Young Adults with Cancer Before and Following Use of a Smartphone-Based Medication Reminder App

Linder

Macpherson

et al. 2019

Journal of Adolescent and Young Adult Oncology

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This study evaluated oral medication adherence among adolescents and young adults (AYAs) with cancer during a trial of a smartphone-based medication reminder application (app). Methods: Twenty-three AYAs receiving at least one prescribed, scheduled oral medication related to their outpatient cancer treatment participated in this 12-week single-group interrupted time series longitudinal design study. Baseline oral medication adherence was monitored using electronic monitoring caps for 4 weeks. Participants then used a medication reminder app and continued to have their oral medication adherence monitored for 8 weeks. Participants completed an electronically administered weekly survey addressing perceived adherence and reasons for nonadherence. Results: Four adherence phenotypes were identified using visual graphical analysis of individual participants' weekly adherence: (1) high adherence during the preintervention and intervention periods (n = 13), (2) low preintervention adherence and improved adherence during the intervention period (n = 3), (3) low adherence during both periods (n = 6), and (4) high preintervention adherence and low adherence during the intervention period (n = 1). Growth curve models did not show significant changes in adherence by preintervention versus intervention trajectories (p > 0.05); however, the variance in adherence during the intervention narrowed for more highly adherent AYAs. ''Forgetfulness'' was the most frequently reported reason for nonadherence. Conclusion: Although overall adherence did not improve following use of the app, the variance decreased for more highly adherent participants. Additional or alternative interventions are needed for AYAs with persistently poor adherence. Assessment of adherence patterns may support individualized recommendation of tailored interventions.

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“…High CV TAC may reflect a number of factors, including adherence to prescribed medical regimen, barriers to laboratory services (timing and ability to get to laboratory), and variations in medical provider clinical patterns pre‐ and post‐transfer. Prior studies utilizing electronic monitoring of TAC intake in kidney transplant recipients found no association between TAC trough level variability and adherence to their medical regimen . As previously discussed, there may be an influence of number of TAC levels, as well as the effect of a medical provider changing TAC trough targets pre‐ and post‐transfer of care which contributes to variability of TAC levels.…”

Section: Discussionmentioning

confidence: 93%

“…Prior studies utilizing electronic monitoring of TAC intake in kidney transplant recipients found no association between TAC trough level variability and adherence to their medical regimen. 21,22 As previously discussed, there may be an influence of number of TAC levels, as well as the effect of a medical provider changing TAC trough targets preand post-transfer of care which contributes to variability of TAC levels. Therefore, we cannot suggest a causal pathway, but rather point out a relationship between high CV TAC and allograft loss.…”

Section: Discussionmentioning

confidence: 99%

The effect of transfer to adult transplant care on kidney function and immunosuppressant drug level variability in pediatric kidney transplant recipients

Fernández

Amaral

Shaw

et al. 2019

Pediatric Transplantation

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Adolescent age at time of transplant has been recognized as a risk factor for renal allograft loss. Increased risk for graft failure may persist from adolescence to young adulthood. Transfer of care is hypothesized as a risk factor for non‐adherence and graft loss. We explored whether kidney allograft function declined at an accelerated rate after transfer of care to adult transplant centers and whether coefficient of variation of tacrolimus (CV TAC) trough levels predicted allograft loss. Single‐center, retrospective chart review was performed for pediatric kidney transplant recipients who received transplants between 1999 and 2011. Change in eGFR pre‐ and post‐transfer was performed via a linear mixed‐effects model. CV TAC was calculated in transplant recipients with TAC data pre‐ and post‐transfer. t test was performed to determine the difference between means of CV TAC in subjects with and without allograft loss following transfer of care. Of the 138 subjects who transferred to adult care, 47 subjects with data pre‐ and post‐transfer demonstrated a decrease in the rate of eGFR decline post‐transfer from 8.0 mL/min/1.73 m2 per year to 2.1 mL/min/1.73 m2 per year, an ~80% decrease in eGFR decline post‐transfer (P = 0.01). Twenty‐four subjects had CV TAC data pre‐ and post‐transfer of care. Pretransfer CV TAC for subjects with allograft loss post‐transfer was significantly higher than in subjects without allograft loss (49% vs 26%, P < 0.05). Transfer of care was not independently associated with acceleration in eGFR decline. CV TAC may aid in identifying patients at risk for allograft loss post‐transfer.

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A Randomized Trial of a Multicomponent Intervention to Promote Medication Adherence: The Teen Adherence in Kidney Transplant Effectiveness of Intervention Trial (TAKE-IT)

Abstract: Registered at ClinicalTrials.gov with study number NCT01356277.

Cited by 115 publications

References 52 publications

Evaluation of tools for annual capture of adherence to immunosuppressive medications after renal transplantation - a single-centre open prospective trial

Evaluation of tools for annual capture of adherence to immunosuppressive medications after renal transplantation - a single-centre open prospective trial

Oral Medication Adherence Among Adolescents and Young Adults with Cancer Before and Following Use of a Smartphone-Based Medication Reminder App

The effect of transfer to adult transplant care on kidney function and immunosuppressant drug level variability in pediatric kidney transplant recipients

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