Assessing an adherence intervention for adolescents with kidney transplants

简介（由申请人提供）：候选人：阿马拉尔博士是亚特兰大埃默里大学儿童保健中心（埃默里choa）的儿科肾病专家，在那里她开办了一个青少年过渡诊所。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)成为发展以证据为基础的青少年慢性疾病过渡护理策略的先驱；2)评估和发展消除移植健康差异的实践。她提出的项目就是为了实现第一个目标。研究：在这个项目中，Dr. Amaral建议解决青少年肾移植受者由于不依从而导致同种异体移植成活率差的重要问题。她的第一个目标是开展一项单中心II期随机对照试验，以测试同伴指导计划的有效性，以改善接受肾脏移植的青少年的药物依从性和健康相关生活质量（HRQOL）。她将通过书面调查来衡量HRQOL，并通过简短用药问卷和药房补充数据来衡量药物依从性。她的第二个目标是确定同伴指导影响药物依从性和HRQOL的机制。具体来说，她假设同伴指导提供了社会支持，提高了患者的自我效能感，并带来了积极的健康结果。她提议的同侪辅导计划将以电话为基础，导师和学员之间的电子沟通被视为双方都同意。这种方法新颖而实用，可以在病人的“真实世界”中与他们见面。环境：Emory-CHOA儿科移植中心是全国最繁忙的中心之一，为Amaral博士的单一中心建议提供了丰富的患者群体。Amaral博士组建了一个由儿科（Larry Greenbaum博士）、移植外科（Allan Kirk博士）和公共卫生学院（Arriola博士和Easley教授）组成的坚实导师团队，以促进她的成功。Arriola博士在同侪辅导方面有研究经验，曾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为阿马拉尔博士的职业发展提供了几门相关课程。儿科学系致力于年轻研究者的成功，为统计分析、资助和手稿准备提供支持，并通过儿科研究中心与研究界接触。该项目的目标是通过改善药物依从性，从而改善接受实体器官移植的青少年的健康状况，从而改善同种异体移植的长期功能。维持移植功能的患者比移植失败并重新进行透析的患者有更好的生活质量和更长的寿命。这个项目的目标与美国国立卫生研究院支持调查工作以改善健康和拯救生命的使命非常吻合。

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.