Association between day of the week and medication adherence among adolescent and young adult kidney transplant recipients.

2019

2019 Sep 10

1600-6143

<p>Disruption of usual routines may hinder adherence, increasing the risk of rejection. We aimed to compare weekend versus weekday medication adherence among adolescent and young adult kidney transplant recipients, hypothesizing poorer adherence on weekends. We examined data from the Teen Adherence in Kidney transplant Effectiveness of Intervention Trial (TAKE-IT). We assessed the 3-month run-in period (no intervention) and the 12-month intervention interval, considering a potential interaction between weekend/weekday and treatment group. Adherence was monitored using electronic pillboxes in participants 11-24 years followed in 8 transplant centers in Canada and the United States. We used logistic regression with generalized estimating equations to estimate the association between weekends/weekdays and each of perfect taking (100% of prescribed doses taken) and timing (100% of prescribed doses taken on time) adherence. Taking (OR=0.72 (95%CI 0.65-0.79)) and timing (OR=0.66 (95%CI 0.59-0.74)) adherence were poorer on weekends than weekdays in the run-in (136 participants), and the intervention interval (taking OR=0.74 (0.67-0.81) and timing OR=0.71 (95%CI 0.65-0.77)). There was no interaction by treatment group (64 intervention and 74 control participants). Weekends represent a disruption of regular routines, posing a threat to adherence. Patients and families should be encouraged to develop strategies to maintain adherence when routines are disrupted.</p>

10.1111/ajt.15590

Am. J. Transplant.

31507087

A Randomized Trial of a Multicomponent Intervention to Promote Medication Adherence: The Teen Adherence in Kidney Transplant Effectiveness of Intervention Trial (TAKE-IT).

2018

2018 Mar 15

1523-6838

<p><strong>BACKGROUND: </strong>Poor adherence to immunosuppressive medications is a major cause of premature graft loss among children and young adults. Multicomponent interventions have shown promise but have not been fully evaluated.</p>

<p><strong>STUDY DESIGN: </strong>Unblinded parallel-arm randomized trial to assess the efficacy of a clinic-based adherence-promoting intervention.</p>

<p><strong>SETTING &amp; PARTICIPANTS: </strong>Prevalent kidney transplant recipients 11 to 24 years of age and 3 or more months posttransplantation at 8 kidney transplantation centers in Canada and the United States (February 2012 to May 2016) were included.</p>

<p><strong>INTERVENTION: </strong>Adherence was electronically monitored in all participants during a 3-month run-in, followed by a 12-month intervention. Participants assigned to the TAKE-IT intervention could choose to receive text message, e-mail, and/or visual cue dose reminders and met with a coach at 3-month intervals when adherence data from the prior 3 months were reviewed with the participant. "Action-Focused Problem Solving" was used to address adherence barriers selected as important by the participant. Participants assigned to the control group met with coaches at 3-month intervals but received no feedback about adherence data.</p>

<p><strong>OUTCOMES: </strong>The primary outcomes were electronically measured "taking" adherence (the proportion of prescribed doses of immunosuppressive medications taken) and "timing" adherence (the proportion of doses of immunosuppressive medications taken between 1 hour before and 2 hours after the prescribed time of administration) on each day of observation. Secondary outcomes included the standard deviation of tacrolimus trough concentrations, self-reported adherence, acute rejection, and graft failure.</p>

<p><strong>RESULTS: </strong>81 patients were assigned to intervention (median age, 15.5 years; 57% male) and 88 to the control group (median age, 15.8 years; 61% male). Electronic adherence data were available for 64 intervention and 74 control participants. Participants in the intervention group had significantly greater odds of taking prescribed medications (OR, 1.66; 95% CI, 1.15-2.39) and taking medications at or near the prescribed time (OR, 1.74; 95% CI, 1.21-2.50) than controls.</p>

<p><strong>LIMITATIONS: </strong>Lack of electronic adherence data for some participants may have introduced bias. There was low statistical power for clinical outcomes.</p>

<p><strong>CONCLUSIONS: </strong>The multicomponent TAKE-IT intervention resulted in significantly better medication adherence than the control condition. Better medication adherence may result in improved graft outcomes, but this will need to be demonstrated in larger studies.</p>

<p><strong>TRIAL REGISTRATION: </strong>Registered at ClinicalTrials.gov with study number NCT01356277.</p>

10.1053/j.ajkd.2017.12.012

29602631