Discharge medication procurement and education after kidney transplantation

Abstract

Adherence to the prescribed medication regimen is critical for success after organ transplantation. Over one-third of kidney graft losses are associated with medication nonadherence, and the odds of graft failure increase 7-fold in nonadherent compared with adherent patients. 1 It is estimated that kidney transplant patients take on average 8 medications per day, which can equate to 15-20 tablets or capsules per day. Education and training on the use of immunosuppressant medications as part of a complex post-transplant medication regimen are of paramount importance in order to set recipients up for success. 2 Every transplant program must consider and develop their strategy for discharge medication procurement and patient education. Patient education is required by the Centers for Medicare and Medicaid Services (CMS) for all United States (US) transplant Abstract Adherence to immunosuppressant medications is a key determinant of success following organ transplantation. Medication procurement and education are precursory. In March 2018, Medicare announced a rule change interpreted to prohibit delivery of Part B-covered immunosuppressive drugs to hospitals. A subsequent Medicare announcement clarified that immunosuppressive drug delivery to hospitals is acceptable, effective April 2019. To promulgate the perceived importance of medication delivery to hospitals among key providers of transplant discharge education, a 25question descriptive survey was distributed between May and July 2018 to pharmacists affiliated with each active US kidney transplant program (n = 238). Survey goals were to describe discharge medication procurement practices, discharge medication teaching practices, and attitudes toward the value of medication education. A total of 155 responses were received from 115 different transplant centers. A majority (93%) of respondents require discharge medications to be onsite prior to hospital discharge. A majority (81%) of respondents use discharge medications during medication education. Acquisition of immunosuppressant medications and their deliveryto the inpatient environment prior to discharge for the purpose of medication education is a common practice, is viewed as important, and serves to enhance discharge education, ensure safe transitions of care, and encourage medication adherence.

C4 article: Challenges and solutions to appropriate and timely medication access in transplantation in the United States

“…Standard practice calls for transplant patients to have their discharge medications in hand before leaving the hospital . In spring of 2018, Medicare prohibited bedside delivery of transplant immunosuppression prior to discharge, causing a disruption in discharge planning in many centers.…”

“…Acquisition of immunosuppressant medications and delivery to the inpatient environment before hospital discharge for medication education is a common practice, serves to enhance discharge education, ensures safe transitions of care, and is considered an essential element of patient education. It is critical to establishing a foundation for medication adherence . Various members of the transplant team are responsible for patient education.…”

“…The C4 Article, standing for current, controversial, collaborative, and crowdsourced knowledge, was introduced by Allan Kirk in 2018 and thus a novel publishing experiment focused on constructive interactive academic dialogue on difficult topics in transplantation was born . This second C4 Article provides an opportunity for stakeholders to describe the challenges that they face in the United States as well as propose practical solutions.…”

From Nonadherence to Adherence

“…early. 60,61 Many observational studies showed a patient preference for the once-daily formulation (QD) of tacrolimus and expressed a positive effect on quality of life. 62,63 The first prospective randomized controlled trial that examined the effect of switching from the twice-daily (BID) to the once-daily formulation of tacrolimus in kidney recipients on medication adherence was the ADMIRAD study.…”