Impact of a Pharmaceutical Care Program on Liver Transplant Patients’ Compliance With Immunosuppressive Medication: A Prospective, Randomized, Controlled Trial Using Electronic Monitoring

Klein, Anja; Otto, Gerd; Krämer, Irene

doi:10.1097/tp.0b013e318199d122

Cited by 74 publications

(82 citation statements)

References 23 publications

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“…In studies in which multiple intervention components were part of the adherence-enhancing intervention, each intervention component was reported with a different frequency. In several studies the frequencies were not clearly described [40–42]. …”

Section: Resultsmentioning

confidence: 99%

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Identification and Assessment of Adherence-Enhancing Interventions in Studies Assessing Medication Adherence Through Electronically Compiled Drug Dosing Histories: A Systematic Literature Review and Meta-Analysis

Demonceau¹,

Ruppar

Kristanto³

et al. 2013

Drugs

286

268

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BackgroundNon-adherence to medications is prevalent across all medical conditions that include ambulatory pharmacotherapy and is thus a major barrier to achieving the benefits of otherwise effective medicines.ObjectiveThe objective of this systematic review was to identify and to compare the efficacy of strategies and components thereof that improve implementation of the prescribed drug dosing regimen and maintain long-term persistence, based on quantitative evaluation of effect sizes across the aggregated trials.Data sourcesMEDLINE, EMBASE, CINAHL, the Cochrane Library, and PsycINFO were systematically searched for randomized controlled trials that tested the efficacy of adherence-enhancing strategies with self-administered medications. The searches were limited to papers in the English language and were included from database inception to 31 December 2011.Study selectionOur review included randomized controlled trials in which adherence was assessed by electronically compiled drug dosing histories. Five thousand four hundred studies were screened. Eligibility assessment was performed independently by two reviewers. A structured data collection sheet was developed to extract data from each study.Study appraisal and synthesis methodsThe adherence-enhancing components were classified in eight categories. Quality of the papers was assessed using the criteria of the Cochrane Handbook for Systematic Reviews of Interventions guidelines to assess potential bias. A combined adherence outcome was derived from the different adherence variables available in the studies by extracting from each paper the available adherence summary variables in a pre-defined order (correct dosing, taking adherence, timing adherence, percentage of adherent patients). To study the association between the adherence-enhancing components and their effect on adherence, a linear meta-regression model, based on mean adherence point estimates, and a meta-analysis were conducted.ResultsSeventy-nine clinical trials published between 1995 and December 2011 were included in the review. Patients randomized to an intervention group had an average combined adherence outcome of 74.3 %, which was 14.1 % higher than in patients randomized to the control group (60.2 %). The linear meta-regression analysis with stepwise variable selection estimated an 8.8 % increase in adherence when the intervention included feedback to the patients of their recent dosing history (EM-feedback) (p < 0.01) and a 5.0 % increase in adherence when the intervention included a cognitive-educational component (p = 0.02). In addition, the effect of interventions on adherence decreased by 1.1 % each month. Sensitivity analysis by selecting only high-quality papers confirmed the robustness of the model. The random effects model in the meta-analysis, conducted on 48 studies, confirmed the above findings and showed that the improvement in adherence was 19.8 % (95 % CI 10.7–28.9 %) among patients receiving EM-feedback, almost double the improvement in adherence for studies that did not inclu...

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Section: Resultsmentioning

confidence: 99%

“…In the majority of these studies, however, adherence-enhancing interventions aimed to enhance medication adherence with all prescribed medications. In four studies [38, 40, 52, 53], it was not clear which and how many medications were monitored.…”

Section: Resultsmentioning

confidence: 99%

Identification and Assessment of Adherence-Enhancing Interventions in Studies Assessing Medication Adherence Through Electronically Compiled Drug Dosing Histories: A Systematic Literature Review and Meta-Analysis

Demonceau¹,

Ruppar

Kristanto³

et al. 2013

Drugs

286

268

View full text Add to dashboard Cite

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“…Reported educational, counseling and psychologic interventions appear promising as effective interventions. 29,30 Larger studies with follow-up of clinical data in lung transplant recipients are needed to understand the ultimate consequence of NA, that is, bronchiolitis obliterans syndrome, and to clarify the extent to which NA makes a clinical difference and for which transplant recipients.…”

Section: Future Perspectivesmentioning

confidence: 98%

Adherence to immunosuppression in adult lung transplant recipients: Prevalence and risk factors

Bosma

Vermeulen

Verschuuren

et al. 2011

The Journal of Heart and Lung Transplantation

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“…Currently, family centred multidisciplinary care strategies seem to be the most effective in improving adherence to PTM 4 10 11. WHO has endorsed the implementation of pharmaceutical care within the patients’ care process,12 thus, pharmacists’ active involvement in patient-centred practice has increased in recent years with a positive impact on patient outcomes, such as improving adherence to medications 13 14. These concepts of family centred pharmaceutical care are well integrated in the patients’ care process at the Birmingham Children's Hospital (BCH) in the UK.…”

Section: Introductionmentioning

confidence: 99%

Parents and carers of patients who had liver transplants: opinions and experiences of medication issues

et al. 2014

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Purpose Birmingham Children's Hospital in the UK provides family centred care for post-transplant medication (PTM) management. Nevertheless, PTM is often considered a burden for patients, and can be difficult to manage. This study was designed to identify the main medication issues encountered by children and their parents in order to find suitable means to improve their care management. Method Anonymised multifactorial, cross-sectional, single-site survey. Parents of children transplanted from January 2011 were recruited following two strategies: (1) self-completion of questionnaire at the outpatient department over a period of 4 weeks during May 2013, (2) telephone completion by random selection of 30 parents. Results were analysed using MS Excel 2010. Results 37 parents were recruited. Medication supply problems concerned 12 (32.4%) parents. 30 (81.1%) parents declared having almost run out of medicines, but no children missed an immunosuppressant dose. 9 (24.3%) parents experienced medication-administration problems, and 14 (37.8%) blood test issues. 14 (37.8%) parents felt they had an inadequate knowledge of side effects. However, 30 (81.1%) parents thought that their training was excellent or very good, and 36 (97.5%) that the written information provided was comprehensible and accurate. Among proposed improvements, parents’ preferences were for an online learning tool (OLT), an explanatory comic book (CB) for children and pharmaceutical consultations (PC). Conclusions To our knowledge, this study is the most comprehensive published audit concerning the care process of PTM. Although parents seemed particularly satisfied by the current training and written information, many experienced issues linked to PTM management. Based on parents’ preferences, a working party is currently considering service development options (OLT, CB, PC).

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Impact of a Pharmaceutical Care Program on Liver Transplant Patients’ Compliance With Immunosuppressive Medication: A Prospective, Randomized, Controlled Trial Using Electronic Monitoring

Cited by 74 publications

References 23 publications

Identification and Assessment of Adherence-Enhancing Interventions in Studies Assessing Medication Adherence Through Electronically Compiled Drug Dosing Histories: A Systematic Literature Review and Meta-Analysis

Identification and Assessment of Adherence-Enhancing Interventions in Studies Assessing Medication Adherence Through Electronically Compiled Drug Dosing Histories: A Systematic Literature Review and Meta-Analysis

Adherence to immunosuppression in adult lung transplant recipients: Prevalence and risk factors

Parents and carers of patients who had liver transplants: opinions and experiences of medication issues

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