Supporting medication adherence in renal transplantation (SMART): a pilot RCT to improve adherence to immunosuppressive regimens

Geest, Sabina De; Schäfer-Keller, Petra; Denhaerynck, Kris; Thannberger, Nicole; Köfer, S; Böck, Andreas; Surber, Christian; Steiger, Jürg

doi:10.1111/j.1399-0012.2006.00493.x

Cited by 113 publications

(167 citation statements)

References 39 publications

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“…Therefore, effective, evidence-based intervention strategies are needed to promote long-term IST adherence in RTRs, which in turn results in improved graft survival and may impact other outcomes such as decreased healthcare utilizations and costs. However, previous studies of interventions targeting IST adherence among adult RTRs have produced inconsistent results and have not assessed outcomes linked to adherence such as healthcare utilizations and costs (6)(7)(8)(9). The current RCT is the first study to address this gap in the knowledge base through examination of the effects of a behavioral contract intervention on IST adherence and healthcare utilizations in an adult RTR sample.…”

Section: Discussionmentioning

confidence: 99%

“…Existing studies are hampered by ineffective interventions and/or lack of examination of outcomes related to adherence such as healthcare utilizations and costs, which were found to be associated with decreased IST adherence levels in a retrospective cohort study by Pinsky et al (2,(6)(7)(8)(9). Given the limits of prior published interventional studies, prospective research is needed to evaluate the effects of interventions on IST adherence and healthcare outcomes among adult RTRs.…”

Section: Introductionmentioning

confidence: 99%

“…A search of PubMed (years unlimited) revealed few published studies of interventions targeting IST adherence among adult RTRs (5)(6)(7)(8)(9). Existing studies are hampered by ineffective interventions and/or lack of examination of outcomes related to adherence such as healthcare utilizations and costs, which were found to be associated with decreased IST adherence levels in a retrospective cohort study by Pinsky et al (2,(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

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

Chisholm-Burns

Spivey

Zivin

et al. 2013

American Journal of Transplantation

103

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Chisholm-Burns

Spivey

Zivin

et al. 2013

American Journal of Transplantation

103

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“…24,35 However, in glaucoma, a long-term follow-up is necessary to monitor the effect of poor adherence on clinical outcomes. Okeke et al 16 compared IOP levels at the end of a 3-month follow-up period, but found no difference between groups; this may have been due to the shortterm follow-up period.…”

Section: Discussionmentioning

confidence: 99%

“…It is known that adherence improves with attention, 23 often causing the adherence rate to improve equally in intervention and control groups. 15,24 Education and training in the initial months of commencing therapy helps prevent poor adherence from developing. 25 We focused on specific gaps in knowledge and challenged pre-existing beliefs.…”

Section: Discussionmentioning

confidence: 99%

Individualised patient care as an adjunct to standard care for promoting adherence to ocular hypotensive therapy: an exploratory randomised controlled trial

Gray

Fenerty

Harper

et al. 2011

Eye

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Purpose To evaluate the impact of individualised patient care, as an adjunct to standard care, on adherence to ocular hypotensive therapy. Methods A two-arm, single-masked exploratory randomised controlled trial recruited patients newly prescribed ocular hypotensive therapy. The intervention involved an individual assessment of health-care needs and beliefs and a 1-year follow-up period according to need. The primary outcome was refill adherence, measured by collating prescription and dispensing data for 12 months. Secondary outcomes included self-reported adherence, glaucoma knowledge, beliefs about illness and medicines, quality of care, intraocular pressure (IOP) fluctuation, and changes in clinical management assessed at 12 months. The strength of the intervention was measured following withdrawal by reviewing clinical outcomes for a further 12 months. Results In all, 127 patients were recruited (91% response rate). Intervention-arm patients collected significantly more prescriptions than control-arm patients. Self-report adherence was significantly better in the intervention-arm for patients who forgot drops and those who intentionally missed drops. The intervention group demonstrated significantly more glaucoma knowledge, expressed a significantly stronger belief in the necessity of eye drops and believed that they had more personal control over managing their condition. Control-arm patients had more IOP fluctuation and changes in clinical management. However, this finding only reached significance at 24 months. Conclusion Modelling patient care according to health-care needs and beliefs about illness and medicines can have a significant impact on improving adherence to therapy for this patient group, with the potential benefit of improving clinical outcomes.

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Interventions for improving health literacy in people with chronic kidney disease

Campbell

Dawson

Kirkendall

et al. 2022

Cochrane Database of Systematic Reviews

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Supporting medication adherence in renal transplantation (SMART): a pilot RCT to improve adherence to immunosuppressive regimens

Abstract: Our findings suggest an inclusion effect. Although the intervention in this pilot RCT appeared to add further benefit in medication compliance, a lack of statistical power prevented us from making a strong statistical statement.

Cited by 113 publications

References 39 publications

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

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

Individualised patient care as an adjunct to standard care for promoting adherence to ocular hypotensive therapy: an exploratory randomised controlled trial

Interventions for improving health literacy in people with chronic kidney disease

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