Implementation of a transition of care educational and behavioral intervention to improve medication adherence in kidney transplant patients

Abstract

Objective: The primary objective is to evaluate whether initiating a transition of care process from hospital to community-based care can identify and resolve previously reported reasons for medication nonadherence in kidney transplant patients. A secondary objective is to examine the relationship between improved medication adherence and patient health outcomes such as prevention of rejection, minimization of adverse events, and management of quality of life. Methods: A randomized, singleblind, parallel controlled study wherein 30 kidney transplant patients were to receive either standard education and follow-up or intensive one-on-one pharmacist- led medication education and scheduled follow-up. It involved the integration of a community pharmacist in the transition of care process of kidney transplant patients from inpatient to outpatient care within an integrated health care system. It incorporated educational interventions that address patient-related issues regarding medication nonadherence at point of discharge from the hospital (Day 0), a week after post-discharge (Day 7), and on a regular monthly basis for 6 months. Patients must be >18 years old and newly kidney transplanted or previously discharged and readmitted due to rejection, infection, and/or other poor health prognosis related to kidney transplant. The primary outcome measure of medication adherence was determined using proportion days covered and the secondary outcome measure of patient-reported health outcomes was assessed using Immunosuppressant Therapy Adherence Scale, Immunosuppressant Therapy Barrier Scale, Beliefs About Medication Questionnaire, and Life Satisfaction Index. Descriptive statistics and exploratory graphs will be used to assess the effect of treatment intervention on adherence rate and other secondary outcome measures. Baseline demographic variables will be compared between the two groups using appropriate statistical tests. The probability of being adherent will be analyzed using a logistic regression model using treatment group and other relevant covariates as factors and adjusted odd ratios will be obtained.