Intensified pharmaceutical care is improving immunosuppressive medication adherence in kidney transplant recipients during the first post-transplant year: a quasi-experimental study
Intensified pharmaceutical care is improving immunosuppressive medication adherence in kidney transplant recipients during the first post-transplant year: a quasi-experimental study
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DOI：
10.1093/ndt/gfu207
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发表时间：
2014-08-01
影响因子：
6.1
通讯作者：
Hugo, Christian
中科院分区：
文献类型：
--
作者：
Joost, Robert;Doerje, Frank;Hugo, Christian
药物依从性对于移植患者至关重要，因为不依从性的后果可能导致同种异体移植物丢失，并可能危及生命。采用序贯对照组设计对 74 名肾移植受者进行了一项前瞻性研究，以调查由临床药剂师领导的药物强化护理计划对肾移植后第一年每日药物依从性的影响。对照组的 39 名患者接受了已经建立的标准化药物和移植培训，而强化护理组 (ICG) 的 35 名患者接受了额外的住院和门诊药学护理以及由专门的临床药师提供的咨询。根据 Michie 的说法，使用行为改变技术分类法对应用的干预措施进行聚类和分类。使用药物事件监测系统、药丸计数 (PC)、药物假期 (DH) 发生、Morisky 问卷和自我报告对免疫抑制药物治疗的依从性进行长达 1 年的监测。对 67 名患者（35 名标准护理患者和 32 名 ICG 患者）进行了分析。移植后第一年，与 SCG 患者 (75%) 相比，ICG 患者 (91%) 的 DA 实施显着改善 (P = 0.014)。在开始加强患者护理后的 30-40 天内，每日依从性指标已经得到改善，并在整个研究期间持续进行。强化护理患者在服药依从性（P = 0.006）、PC（P = 0.008）和DH（P = 0.001）方面也表现出明显更好的结果。额外的强化药学护理显着改善了患者的药物依从性，表明所应用的额外护理计划有可能改善器官移植后的结果。
Medication adherence is critical for transplant patients because the consequences of non-adherence can result in allograft loss and may be life threatening.A prospective study with 74 renal transplant recipients using a sequential control group design was performed to investigate the impact of a pharmaceutical intensified care programme led by a clinical pharmacist on daily drug adherence during the first year after renal transplantation. Thirty-nine patients of the control group received the already established standardized drug and transplant training, while 35 patients of the intensified care group (ICG) received additional inpatient and outpatient pharmaceutical care and counselling by a dedicated clinical pharmacist. Applied interventions were clustered and classified using the behaviour change technique taxonomy according to Michie. Adherence to immunosuppressive drug therapy was monitored up to 1 year using a medication event monitoring system, pill count (PC), drug holiday (DH) occurrence, Morisky questionnaire and self-report.Sixty-seven patients (35 of the standard care and 32 of the ICG) were analysed. Implementation of DA was significantly (P = 0.014) improved in patients of the ICG (91%) compared with SCG (75%) during the first year after transplantion. Daily adherence measures were already improved within 30-40 days after start of intensified patient care and continued throughout the study period. Intensified care patients also showed significantly better results for taking adherence (P = 0.006), PC (P = 0.008) and DHs (P = 0.001).The additional, intensified pharmaceutical care improved patients' medication adherence remarkably, suggesting that the applied additional care programme has the potential to improve outcomes after organ transplantation.