Quality Improvement Targeting Adherence During the Transition from a Pediatric to Adult Liver Transplant Clinic

Abstract

The transition from pediatric to adult transplant care is a high risk period for non-adherence and poor health outcomes. This article describes a quality improvement initiative integrated into a pediatric liver transplant program that focused on improving outcomes following the transfer from pediatric to adult liver transplant care. Using improvement science methodology, we evaluated the impact of our center's transition readiness skills (TRS) program by conducting a chart review of 45 pediatric liver transplant recipients who transferred to adult transplant care. Medication adherence, clinic attendance, and health status variables were examined for the year pre-transfer and first year post-transfer. 19 recipients transferred without participating in the TRS program (control group) and 26 recipients participated in the program prior to transferring to the adult clinic (TRS group). The TRS group was significantly older at the time of transfer, more adherent with medications, and more likely to attend their first adult clinic visit compared to the control group. Among the TRS group, better adolescent and parent regimen knowledge were associated with greater adherence to post-transfer clinic appointments. Transition planning should focus on the gradual shift in responsibility for health management tasks, including clinic attendance, from parent to adolescent. There may be support for extending transition support for at least 1 year post-transfer to promote adherence.

Disparities in Waitlist and Posttransplantation Outcomes in Liver Transplant Registrants and Recipients Aged 18 to 24 Years

“…Novel solutions continue to target the transition between pediatric and adult care with the aim to decrease chronic rejection leading to re-transplantation or death. 2,4,28,29 …”

A systematic review of immunosuppressant adherence interventions in transplant recipients: Decoding the streetlight effect

“…There are two observations we would like to make. First, this "uncoupling" is true for studies that used indirect adherence measures [38][39][40]56,[58][59][60]62,63,65 (many used electronic monitors 56,58,59,65 ), but was not true in studies that used direct measures that relied on medication blood levels. [25][26][27][28]55,64,65 As shown in Table 1, when medication blood levels (or, the degree of fluctuation between levels) improved, 25,26,28 transplant outcomes improved as well; when levels did not improve, 27,55,64,65 transplant outcomes did not improve, either.…”

Mixed‐methods evaluation of a transition and young adult clinic for kidney transplant recipients

“…Existing transition models include modifying existing clinics such as by placing greater emphasis on patient education and designating coordinators to oversee transition and act as a resource for patients, or creating new and more elaborate alternatives such as transition and young adult clinics. 10 The available literature documents the benefits of different transition models, which include better health outcomes, [10][11][12][13] improved adherence to medication, 10,[13][14][15] increased clinic attendance rates, 10,12 better quality of life, 4,16,17 and higher levels of patient satisfaction. 15,18 There are also positive impacts on young patients' autonomy and ability to be responsible for their care 10,11,19 and on their coping mechanisms and psychosocial well-being.…”