Transitioning health care responsibility from caregivers to patient: A pilot study aiming to facilitate medication adherence during this process

Abstract

Transition in pediatric transplant recipients consists of both a physical shift in medical care location as well as a transition in health care responsibilities from caregivers to patients. The purpose of the present study was to test the feasibility of a pilot intervention aiming to facilitate the transition in health care responsibilities from caregivers to patients while patients are still receiving pediatric services. Twenty-two patients were enrolled in a two-session educational protocol aiming to facilitate transition of responsibility. Patients were recruited from an outpatient transplant clinic. Ten were referred because of suspected difficulty in transitioning of care, and 12 were consecutively recruited without any specific a priori concerns. Medication adherence, measured through the use of standard deviations of tacrolimus blood levels, and ALT levels were the medical outcome measures. Complete data are available for 20 patients. Mean ALT levels improved after the follow-up period. For referred patients, adherence and ALT levels improved. Standard deviation of tacrolimus decreased from 3.33 to 2.23, t = 2.52, p = 0.04. Mean ALT decreased from 120.33 to 63.99, t = 3.01, p = 0.01. Maximal ALT values decreased overall from 284.10 to 101.20, t = 2.61, p = 0.03. Our findings suggest that targeted education regarding transition in responsibility for adolescents' own health care is feasible in the outpatient environment and may assist families who are facing this potentially challenging process. A randomized, controlled study with a substantial number of enrolled patients is needed to establish the efficacy of this or other approaches.

Evaluation of Outcomes in Adolescent Inflammatory Bowel Disease Patients Following Transfer From Pediatric to Adult Health Care Services: Case for Transition

“…A previous case-controlled study has reported better medication adherence, particularly to thiopurines, in the setting of a dedicated adolescent clinic [13]. Similar data have been observed in pediatric liver transplant literature, where the posttransplant period of transfer to adult care was associated with poor adherence to medications [17] and the introduction of the process of transition improved medication adherence [18] as recorded in our study cohort. There are some data in the literature to indicate that the autonomy provided by the transition process may be in part responsible for the improved adherence to medication [19].…”

Transition from pediatric to adult care after solid organ transplantation

“…In the latter study, better knowledge of the medication regimen was associated with fewer missed doses, supporting the inclusion of education in future programs [37 ]. Annunziato et al [38 ] reported preliminary work of a targeted educational intervention to facilitate medication adherence in adolescent liver transplant recipients. Adherence improved significantly in patients specifically referred because of clinical concerns.…”

Pediatric Liver Transplantation

“…The increase in non-adherence was due to a number of factors: Pediatric clinics have a more "handson" approach to treatment; changes in insurance status may be associated with a lapse in attendance and IS usage; and the stress of transitioning to less familiar providers may exacer-bate existing individual and familial risk factors compromise adherence. Subsequently, the same group tested a pilot intervention of facilitating transition [85]. Twenty-two patients were enrolled in a two-session educational program providing details of their underlying liver disease and treatment.…”