Improving Outcomes of Renal Transplant Recipients With Behavioral Adherence Contracts: A Randomized Controlled Trial

Abstract

The objective of this randomized controlled trial was to assess the effects of a 1-year behavioral contract intervention on immunosuppressant therapy (IST) adherence and healthcare utilizations and costs among adult renal transplant recipients (RTRs). The sample included adult RTRs who were at least 1 year posttransplant, taking tacrolimus or cyclosporine and served by a specialty pharmacy. Pharmacy refill records were used to measure adherence and monthly questionnaires were used to measure healthcare utilizations. Direct medical costs were estimated using the 2009 Medicare Expenditure Panel Survey. Adherence was analyzed using the GLM procedure and the MIXED procedure of SAS. Rate ratios and 95% confidence intervals were estimated to quantify the rate of utilizing healthcare services relative to treatment assignment. One hundred fifty RTRs were enrolled in the study. Intervention group RTRs (n ¼ 76) had higher adherence than control group RTRs (n ¼ 74) over the study period (p < 0.01). And 76.1% of the intervention group compared with 42.7% of the control group was not hospitalized during the 1-year study period (RR ¼ 1.785; 95% CI: 1.314, 2.425), resulting in cost savings. Thus, evidence supports using behavioral contracts as an effective adherence intervention that may improve healthcare outcomes and lower costs.

Behavioral measures to reduce non-adherence in renal transplant recipients: a prospective randomized controlled trial

“…These educational and behavioral measures proved to be effective in a recent metaanalysis of studies on non-adherence, particularly when the strategies are combined [25]. Similarly, a recent prospective controlled study with randomized design that used a cognitive behavioral intervention achieved a reduction in nonadherence [13]. Others interventions like home visit, telephonic conversations, and self-improvement strategies were also effective in reducing non-adherence [14,16].…”

“…The behavioral strategy involves a series of interactions between the patient and the healthcare professional, seeking an active participation of the patient in their treatment. Few prospective randomized studies have evaluated interventions to reduce non-adherence to immunosuppressants, in transplant recipients [12][13][14][15][16]. Therefore, this study aimed to assess the impact of an educational/counseling program highlighting the importance of immunosuppressive…”

A National Survey Assessing the Current Workforce of Transplant Pharmacists Across Accredited U.S. Solid Organ Transplant Programs

“…Interventions, including improved long-term patient engagement and medication education have been demonstrated to improve adherence. Future efforts, including the use of technology and mobile applications may enhance the success of these proven pharmacist-led medication adherence interventions (21,22). Thus, the profession should work towards incorporation of the transplant pharmacist into the long-term ambulatory management of the transplant recipient as a predominant goal.…”

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients

“…86,87 A randomized controlled trial (RCT) of 150 adult renal transplant patients found that 1-year behavioral contract intervention significantly improved adherence to immunosuppressant therapy. 88 Table 3 highlights some patientlevel interventions for managing nonadherence to immunosuppressive regimens. 82,86 A recently presented RCT that tested the efficacy of a multidimensional, 6-month adherenceenhancing intervention in heart, lung, and liver transplant recipients showed a 16% increase in adherence at the end of the intervention period, an effect that persisted during the 6-month wean-off phase.…”