Assessing an adherence intervention for adolescents with kidney transplants

描述（由申请人提供）：候选人：Amaral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，她在那里开办了一个青少年过渡诊所。她拥有约翰霍普金斯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）成为为患有慢性病的青少年制定循证过渡性护理策略的先驱; 2）评估和制定消除移植中健康差异的做法。她提出的项目是针对这些目标中的第一个。调研：在这个项目中，Amaral博士建议解决由于不依从性导致的青少年肾移植受者移植物存活率低的重要问题。她的第一个目标是进行一项单中心II期随机对照试验，该试验将测试同伴指导计划的有效性，以改善肾移植青少年的药物依从性和健康相关的生活质量（HRQOL）与常规护理相比。她将通过书面调查测量HRQOL，并通过简要药物调查问卷和药房续药数据测量药物依从性。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社会支持，提高病人的自我效能，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，导师和学员双方都认为可以通过电子通信进行交流。这种方法新颖而实用，在患者的“真实的世界”中与患者见面。“环境：埃默里-乔亚儿科移植中心是全国最繁忙的中心之一，为阿马拉尔博士的单中心提案提供了大量的患者。阿马拉尔博士已经组建了一个坚实的导师团队，从该部。儿科（拉里·格林鲍姆博士），部门。移植外科（艾伦柯克博士）和公共卫生学院（阿里奥拉博士和伊斯利教授），以促进她的成功。Arriola博士有同行指导的研究经验，为患有乳腺癌的非洲裔美国妇女开发了一个患者导航程序。罗林斯公共卫生学院提供了几个相关的课程，阿马拉尔博士的职业发展。儿科系致力于年轻研究人员的成功，为统计分析，grananitary和手稿准备提供支持，以及通过儿科研究中心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和长期同种异体移植功能，改善接受实体器官移植的青少年的健康。维持移植功能的患者比移植失败并返回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的使命相匹配，即支持调查工作，以改善健康和拯救生命。

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.