Assessing an adherence intervention for adolescents with kidney transplants

描述(由申请人提供)：应聘者：阿马拉尔博士是亚特兰大埃默里大学儿童保健中心(Emory-Choa)的儿科肾病学家，在那里她创办了一家青少年过渡诊所。她拥有约翰霍普金斯大学公共卫生学院的健康科学硕士学位。她广泛的长期职业目标是：1)成为为患有慢性疾病的青少年制定循证过渡性护理策略的先驱；2)评估和发展消除移植中健康差距的做法。她提出的项目是针对第一个目标的。研究：在这个项目中，阿马拉尔博士建议解决青少年肾移植受者因不坚持而导致的同种异体移植物存活率低这一重要问题。她的第一个目标是进行一项单中心第二阶段随机对照试验，该试验将测试同伴指导计划的有效性，以改善接受肾移植的青少年的服药依从性和健康相关生活质量(HRQOL)，而不是常规护理。她将通过书面调查来测量HRQOL，并通过简短的用药问卷和药房续药数据来衡量用药依从性。她的第二个目标是确定同伴指导影响服药依从性和HRQOL的机制。具体地说，她假设同伴辅导提供社会支持，从而提高患者的自我效能感，并导致积极的健康结果。她提议的同伴指导计划将以电话为基础，电子交流被认为是导师和被辅导者双方都同意的。这种方法既新颖又实用，能在病人的“真实世界”中与病人见面。环境：埃默里-乔阿儿科移植中心是美国最繁忙的中心之一，为阿马拉尔医生的单一中心计划提供了丰富的患者群体。阿马拉尔博士已经组建了一支由国防部导师组成的坚实团队。儿科(拉里·格林鲍姆博士)移植外科医生(Allan Kirk医生)和公共卫生学院(Arriola医生和Easley教授)帮助她取得了成功。阿里奥拉博士在同伴指导方面有研究经验，他为患有乳腺癌的非裔美国女性开发了一个病人导航员项目。罗林斯公共卫生学院提供了几门与阿马拉尔博士的职业发展相关的课程。儿科系致力于青年研究人员的成功，为统计分析、赠款和手稿准备提供支持，并通过儿科研究中心提供与研究界接触的机会。该项目的目的是通过改善药物依从性，从而改善同种异体移植的长期功能，从而改善接受实体器官移植的青少年的健康。保持移植功能的患者比那些移植失败并重新接受透析的患者有更好的生活质量和更长的寿命。该项目的目标与NIH支持调查工作以改善健康和拯救生命的使命很好地匹配。

DESCRIPTION (provided by applicant): Candidate: Dr. Amaral is a pediatric nephrologist at Emory-University, Children's Healthcare of Atlanta (Emory-CHOA), where she has initiated an adolescent transition clinic. She has a Masters in Health Science from Johns Hopkins School of Public Health. Her broad long, term career goals are to 1)become a pioneer in the development of evidence- based transitional care strategies for adolescents with chronic illness and 2)to assess and develop practices to eliminate health disparities in transplantation. Her proposed project is directed toward the first of these goals. Research: In this project, Dr. Amaral proposes to address the important problem of poor allograft survival in adolescent kidney transplant recipients due to nonadherence. Her first aim is to conduct a single center phase II randomized controlled trial that will test the effectiveness of a peer mentoring program to improve medication adherence and health-related quality of life (HRQOL) versus usual care in adolescents with kidney transplants. She will measure HRQOL by written survey and medication adherence by the Brief Medication Questionnaire and pharmacy refill data. Her second aim is to determine the mechanisms by which peer mentoring impacts medication adherence and HRQOL. Specifically, she hypothesizes that peer mentoring provides social support which increases patient self-efficacy and leads to positive health outcomes. Her proposed peer-mentoring program will be telephone-based, with e-communication as deemed mutually agreeable to mentors and mentees. This approach is novel and practical, meeting patients in their "real world." Environment: The Emory-CHOA Pediatric Transplant Center is one of the busiest in the country, providing a rich population of patients for Dr. Amaral's single center proposal. Dr. Amaral has formed a solid team of mentors from the Dept. of Pediatrics (Dr. Larry Greenbaum), Dept. of Transplant Surgery (Dr. Allan Kirk) and School of Public Health (Dr. Arriola and Prof. Easley) to facilitate her success. Dr. Arriola has research experience with peer mentoring, having developed a program of patient navigators for African American women with breast cancer. The Rollins School of Public Health offers several relevant courses to Dr. Amaral's career development. The Department of Pediatrics is committed to the success of young investigators, providing support for statistical analysis, grantsmanship and manuscript preparation as well as opportunities to engage with the research community through the Pediatric Research Center. This project's aims are directed at improving the health of adolescents with solid organ transplants by improving medication adherence and consequently long-term allograft function. Patients who maintain functioning transplants have better quality of life and live longer than those who have failed grafts and return to dialysis. This project's aims are well matched to the NIH's mission to supportive investigative efforts to improve health and save lives.