A Pilot Randomized Controlled Trial to Promote Immunosuppressant Adherence in Adult Kidney Transplant Recipients
A Pilot Randomized Controlled Trial to Promote Immunosuppressant Adherence in Adult Kidney Transplant Recipients
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DOI：
10.1159/000448627
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发表时间：
2017-01-01
期刊：
影响因子：
2.5
通讯作者：
Salifu, Moro
中科院分区：
文献类型：
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作者：
Cukor, Daniel;Ver Halen, Nisha;Salifu, Moro
背景资料：不依从免疫抑制剂药物治疗是肾移植受者的普遍做法，并与移植失败和经济负担的风险增加有关。这项试点研究的目的是测试一个文化敏感的认知行为依从性促进计划是否可以显着提高他克莫司处方的药物依从性，通过电话药丸计数肾移植受者。研究方法：根据3次电话药丸计数，33名成年移植受者对他克莫司处方的依从性低于98%，并随机分配至2次认知行为依从性促进计划或标准护理。该课程是从移植受者的迭代过程发展到2个阶段的小组计划，提供心理教育，解决依从性障碍，培养改善依从性行为的动机，并讨论关于依从性行为的文化信息。结果如下：与对照组相比，干预组显示出显著更高的依从性水平（t = 2.2，p = 0.04），同样，当比较两组之间的变化量时，干预组显示出比对照条件更多的变化（F（22，1）= 12.005，p = 0.003）。他克莫司谷浓度水平被用作依从性的次要指标，虽然平均谷浓度水平没有显著的组间差异，但谷浓度水平的变异性确实随时间显著降低，表明干预组的服药行为更加一致。结论：初步支持试点计划作为一个成功的干预，帮助患者与他们的免疫抑制剂药物。(C)2016 S. Karger AG，巴塞尔
Background: Nonadherence to immunosuppressant medication is a prevalent practice among kidney transplant recipients and has been associated with increased risk for graft failure and economic burden. The aim of this pilot study was to test whether a culturally sensitive cognitive-behavioral adherence promotion program could significantly improve medication adherence to tacrolimus prescription as measured by telephone pill counts among kidney transplant recipients. Methods: Thirty-three adult transplant recipients were less than 98% adherent to tacrolimus prescription based on 3 telephone pill counts and were randomized either to the 2-session cognitive-behavioral adherence promotion program or to standard care. The curriculum was developed from an iterative process with transplant recipients into a 2-session group program that provided psychoeducation, addressed barriers to adherence, fostered motivation to improve adherence behavior, and discussed cultural messages on adherence behavior. Results: The intervention group displayed significantly higher levels of adherence when compared to the control group (t = 2.2, p = 0.04) and similarly, when the amount of change was compared between the groups, the intervention group showed more change than the control condition (F (22,1) = 12.005, p = 0.003). Tacrolimus trough concentration levels were used as a secondary measure of adherence and, while there were no significant between-group differences for mean trough concentration levels, the variability in the trough levels did significantly decrease over time indicating more consistent pill taking behavior in the intervention group. Conclusions: There is preliminary support for the pilot program as a successful intervention in helping patients with their immunosuppressant medication. (C) 2016 S. Karger AG, Basel