Measuring and improving medication adherence in kidney transplant patients

测量和改善肾移植患者的药物依从性

基本信息

批准号：
8129646
负责人：
Daniel Cukor
金额：
$ 7.9万
依托单位：
SUNY DOWNSTATE MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-08-16 至 2012-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8129646
关键词：
Adherence Adult Adverse effects Affect Behavior Therapy Behavioral Cognitive Cognitive Therapy Economic Burden End stage renal failure Epidemic Future Goals Human Immunosuppression Immunosuppressive Agents Intervention Interviewer Kidney Kidney Failure Kidney Transplantation Measures Medical Medical center Meta-Analysis Methods Minority Monitor Organ Outcome Participant Patients Pharmaceutical Preparations Phase Population Public Health Recruitment Activity Regimen Resources Structure Study Subject Telephone Testing Therapeutic immunosuppression Time Transplant Recipients Transplantation United States Visit Waiting Lists coping cost design disorder later incidence prevention economic cost effective intervention graft failure improved medication compliance motivational enhancement therapy pill psychoeducation public health relevance success therapy design

项目摘要

DESCRIPTION (provided by applicant): Lack of adherence to immunosuppressive therapy following kidney transplantation is a serious public health issue, as it is a major contributor to organ loss in this increasingly prevalent medical condition. The major goals of this proposal are to test unannounced phone pill counts as a reliable and valid method of measuring immunosuppressive medication adherence and to test a behavioral intervention designed to improve medication adherence in kidney transplant patients. The study will take place at Downstate Medical Center in Brooklyn. For the assessment phase of the study, subjects will receive an unannounced phone call and be asked to count their immunosuppressive medication pills on the phone with the interviewer. Five more phone visits will take place, with a goal of having subjects receiving a phone call approximately every 2 weeks for 3 months. Subjects whose baseline levels of adherence are less than ideal (below 98%) will be recruited to participate in the second phase of the study, the behavioral intervention. The intervention will be 8 sessions over no more than 12 weeks. The intervention will have sessions devoted to psychoeducation, motivational interviewing, identifying adherence barriers, self monitoring, coping with side effects, develop medication taking strategy, developing support resources, identifying negative affect, behavioral activation, cognitive restructuring, relapse prevention, and planning for the future. Participants who successfully complete the intervention will then undergo another 3 month assessment period, similar to their pre-intervention assessment. This study utilizes a multiple baseline design and will help determine if behavioral intervention is successful at improving medication adherence and immunosupression in kidney transplant patients. PUBLIC HEALTH RELEVANCE: One third of kidney failures are due to medication non-adherence. This study will verify whether unannounced phone pill counts are a reliable and feasible method for immunosuppressive therapy medication adherence in kidney transplant patients and determine if our behavioral intervention is effective at improving medication adherence. This is the first structured trial of a behavioral intervention to improve adherence in this population.

描述（由申请人提供）：肾脏移植后缺乏对免疫抑制治疗的依从性是一个严重的公共卫生问题，因为这是这种日益普遍的医疗状况中器官损失的主要贡献者。该提案的主要目标是测试未经宣布的电话药丸，是一种可靠且有效的方法，用于测量免疫抑制药物依从性并测试旨在改善肾脏移植患者药物依从性的行为干预措施。该研究将在布鲁克林的下州医疗中心进行。对于研究的评估阶段，受试者将接收一个未通知的电话，并要求与面试官在电话上对其免疫抑制药丸进行计数。将再进行五次电话访问，目标是让受试者大约每2周接到电话3个月。将招募依从性基线水平的受试者（低于98％），以参与研究的第二阶段，即行为干预。干预措施将在不超过12周内进行8次课程。该干预措施将举办精神教育，动机访谈，确定依从性障碍，自我监测，应对副作用，制定药物服用策略，制定支持资源，识别负面影响，行为激活，认知重组，预防复发和未来计划。成功完成干预措施的参与者将再进行3个月的评估期，类似于他们的干预前评估。这项研究利用多个基线设计，将有助于确定行为干预是否成功改善了肾脏移植患者的药物依从性和免疫选择。公共卫生相关性：三分之一的肾脏失败是由于药物不遵守引起的。这项研究将验证未经通知的电话药丸计数是否是一种可靠且可行的方法，用于肾脏移植患者的免疫抑制治疗药物依从性，并确定我们的行为干预是否有效改善药物依从性。这是行为干预措施的第一次结构化试验，以提高该人群的依从性。