Medication adherence interventions in transplantation lack information on how to implement findings from randomized controlled trials in real-world settings: A systematic review

Košťálová, Barbora; Ribaut, Janette; Dobbels, Fabienne; Gerull, Sabine; Malá‐Ládová, Kateřina; Zullig, Leah L.; Geest, Sabina De

doi:10.1016/j.trre.2021.100671

Cited by 14 publications

(10 citation statements)

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“…The need for these technologies became increasingly important during the COVID-19 pandemic (Agh et al, 2021). However, currently MAEIs are mainly used within clinical research settings and little is known about their implementation in routine clinical practice (Zullig et al, 2019;Kostalova et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Reimbursed Medication Adherence Enhancing Interventions in European Countries: Results of the EUREcA Study

et al. 2022

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Introduction: Current literature lacks detailed understanding of the reimbursement framework of medication adherence enhancing interventions (MAEIs). As part of the ENABLE COST Action, the EUREcA (“EUropen REimbursement strategies for interventions targeting medication Adherence”) study aimed to provide an in-depth overview of reimbursed MAEIs currently available in European countries at national and regional levels and to pave the way for further MAEIs to be implemented in the future.Methods: A web-based, cross-sectional survey was performed across 38 European countries and Israel. The survey questionnaire was developed as a result of an iterative process of discussion informed by a desk review. The survey was performed among invited ENABLE collaborators from June to July 2021. Besides descriptive analysis, association between country income and health care expenditure, and the availability of reimbursed MAEIs were also assessed.Results: The survey identified 13 reimbursed MAEIs in nine countries: multi-dose drug dispensing (n = 5), medication review (n = 4), smart device (n = 2), mobile application (n = 1), and patient education (n = 1). The median GDP per capita of countries having ≥1 reimbursed MAEI was significantly higher compared to countries having no reimbursed adherence intervention (33,888 EUR vs 16,620 EUR, respectively; p = 0.05).Conclusions: Our findings highlight that to date only a small number of MAEIs have been reimbursed in European countries. Comprehensive health technology assessment recommendations and multi-stakeholder collaboration could help removing barriers related to the implementation and reimbursement of MAEIs.

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Section: Introductionmentioning

confidence: 99%

Reimbursed Medication Adherence Enhancing Interventions in European Countries: Results of the EUREcA Study

et al. 2022

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“…Although context's importance to implementation has been emphasized, only a minority of IS studies show thorough contextual analyses, i.e., including a theoretical underpinning, using empirical evidence to identify relevant contextual factors, involving stakeholders, reporting how contextual finding inform further study phases of IS projects (e.g., intervention development/adaptation, selection of implementation strategies) (42)(43)(44). This might reflect the fact that contextual analysis tends to be poorly described, and a huge variability in methodological approaches is applied to it (26,45,46).…”

Section: Current Approaches To Contextual Analysismentioning

confidence: 99%

Understanding dynamic complexity in context—Enriching contextual analysis in implementation science from a constructivist perspective

et al. 2022

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Context in implementation science includes not only characteristics of a setting in which an intervention will be delivered, but also social systems (e.g., interrelationships). Context is dynamic and interacts with both, the intervention and its implementation. Therefore, contextual analysis is recognized as an indispensable part of implementation science methodology: it provides the foundation for successful and sustainable implementation projects. Yet, driven by the prevailing post-positivist understanding of context, contextual analysis typically focuses on individual characteristics of context i.e., contextual dynamics and interactions go unnoticed. Conducting contextual analysis from a constructivist perspective promotes a multilayered approach, building a more comprehensive understanding of context, and thus facilitating successful implementation. In this article, we highlight the limitations of prevailing perspectives on context and approaches to contextual analysis. We then describe how contextual analysis can be enriched by working from a constructivist perspective. We finish with a discussion of the methodological and practical implications the proposed changes would entail. Emerging literature attempts to address both the concept of context and methods for contextual analysis. Various theories, models and frameworks consider context, however, many of these are reductionistic and do not acknowledge the dynamic nature of context or interactions within it. To complement recent conceptualizations of context, we suggest consider the following five constructivist concepts: 1) social space; 2) social place; 3) agency; 4) sensation; and 5) embodiment. We demonstrate the value of these concepts using COVID-19 vaccination uptake as an example and integrate the concepts in the Context and Implementation of Complex Interventions (CICI) framework—an implementation science framework that pays ample attention to context. To study context from a constructivist perspective, we also suggest additional considerations in view of methodologies for data collection and analysis, e.g., rapid ethnographic methods. A constructivist perspective contributes to a stronger conceptualization of contextual analysis. Considering the five constructivist concepts helps to overcome contextual analysis' current shortcomings, while revealing complex dynamics that usually go unnoticed. Thus, more comprehensive understanding of context can be developed to inform subsequent phases of an implementation project, thereby maximizing an intervention's uptake and sustainability.

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“…Even better effects were observed in studies, which took an individualized approach or used more frequent interventions ( Bender et al, 2011 ). However, as several studies have shown, final recommendations on a certain adherence intervention cannot be made so far, and further research is urgently needed especially translated into daily clinical practice ( Zhu et al, 2017 ; Duncan et al, 2018 ; Foster et al, 2018 ; Kostalova et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Improving adherence to immunosuppression after liver or kidney transplantation in individuals with impairments in personality functioning – A randomized controlled single center feasibility study

Wagner-Skacel

Fink²,

Kahn³

et al. 2023

Front. Psychol.

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IntroductionAlthough adherence to immunosuppressive medication is the key factor for long-term graft survival today, 20–70% of transplant recipients are non-adherent to their immunosuppressive medication.ObjectiveA prospective, randomized, controlled single-center feasibility study was designed to evaluate the impact of a step guided multicomponent interprofessional intervention program for patients after kidney or liver transplantation on adherence to their immunosuppressive medication in daily clinical practice.Materials and methodsThe intervention consisted of group therapy and daily training as well as individual sessions in a step guided approach. The primary endpoint of the study was adherence to immunosuppression as assessed with the “Basel Assessment of Adherence to Immunosuppressive Medications Scale” (BAASIS). The coefficient of variation (CV%) of Tacrolimus (TAC) through levels and the level of personality functioning was a secondary endpoint. We conducted six monthly follow-up visits.ResultsForty-one age- and sex-matched patients [19 females, 58.5 (SD = 10.56) years old, 22 kidney- and 19 liver transplantation] were randomized to the intervention- (N = 21) or control-group (N = 20). No differences between intervention- and control groups were found in the primary endpoint adherence and CV% of TAC. However, in further exploratory analyses, we observed that individuals with higher impairments in personality functioning showed higher CV% of TAC in the controls. The intervention might compensate personality-related susceptibility to poor adherence as evident in CV% of TAC.DiscussionThe results of the feasibility study showed that this intervention program was highly accepted in the clinical setting. The Intervention group could compensate higher CV% of TAC after liver or kidney transplantation in individuals with lower levels of personality functioning and non-adherence.Clinical trial registrationClinicalTrials.gov, identifier NCT04207125.

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Medication adherence interventions in transplantation lack information on how to implement findings from randomized controlled trials in real-world settings: A systematic review

Cited by 14 publications

References 86 publications

Reimbursed Medication Adherence Enhancing Interventions in European Countries: Results of the EUREcA Study

Reimbursed Medication Adherence Enhancing Interventions in European Countries: Results of the EUREcA Study

Understanding dynamic complexity in context—Enriching contextual analysis in implementation science from a constructivist perspective

Improving adherence to immunosuppression after liver or kidney transplantation in individuals with impairments in personality functioning – A randomized controlled single center feasibility study

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