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Behavioral measures to reduce non-adherence in renal transplant recipients: a prospective randomized controlled trial

  • Nephrology - Original article
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Abstract

Purpose

Solid-organ transplant recipients present a high rate of non-adherence to drug treatment. Few interventional studies have included approaches aimed at increasing adherence. The objective of this study was to evaluate the impact of an educational and behavioral strategy on treatment adherence of kidney transplant recipients.

Methods

In a randomized prospective study, incident renal transplant patients (n = 111) were divided into two groups: control group (received usual transplant patient education) and treatment group (usual transplant patient education plus ten additional weekly 30-min education/counseling sessions about immunosuppressive drugs and behavioral changes). Treatment adherence was assessed using ITAS adherence questionnaire after 3 months. Renal function at 3, 6, and 12 months, and the incidence of transplant rejection were evaluated.

Results

The non-adherence rates were 46.4 and 14.5 % in the control and treatment groups (p = 0.001), respectively. The relative risk for non-adherence was 2.59 times (CI 1.38–4.88) higher in the control group. Multivariate analysis demonstrated a 5.84 times (CI 1.8–18.8, p = 0.003) higher risk of non-adherence in the control group. There were no differences in renal function and rejection rates between groups.

Conclusions

A behavioral and educational strategy addressing the patient’s perceptions and knowledge about the anti-rejection drugs significantly improved the short-term adherence to immunosuppressive therapy.

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Authors and Affiliations

  1. Department of Internal Medicine - UNESP, Univ Estadual Paulista, Rubião Jr, S/N, Botucatu, SP, 18.618-970, Brazil

    Márcia Fátima Faraldo Martinez Garcia, Ariane Moyses Bravin, Paula Dalsoglio Garcia, Mariana Moraes Contti, Hong Si Nga, Henrique Mochida Takase & Luis Gustavo Modelli de Andrade

Authors
  1. Márcia Fátima Faraldo Martinez Garcia
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  2. Ariane Moyses Bravin
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  3. Paula Dalsoglio Garcia
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  4. Mariana Moraes Contti
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  5. Hong Si Nga
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  6. Henrique Mochida Takase
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  7. Luis Gustavo Modelli de Andrade
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Corresponding author

Correspondence to Luis Gustavo Modelli de Andrade.

Ethics declarations

Conflict of interest

Garcia MFFM declares that she has no conflict of interest; Bravin AM declares that she has no conflict of interest; Garcia PD declares that she has no conflict of interest; Nga HS declares that she has no conflict of interest; Takase HM declares that he has no conflict of interest; and Andrade LGM declares that he has no conflict of interest.

Ethical approval

All procedures performed in this work were in accordance with the ethical standards of the institutional ethics committee (under No. 3817/2011) and with the 1964 Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Appendix

Appendix

Educational/interventional items and behavioral approaches addressed in treatment group

  1. 1.

    To ensure that patients are familiar with their medications regarding their dosage, name, and reason for prescription. These points were reinforced at every consultation;

  2. 2.

    To inform about the possible adverse effects of the medication;

  3. 3.

    To provide written instructions in addition to the regular prescription regarding each change in dose of the drug or its frequency;

  4. 4.

    To develop the understanding that the patient must take immunosuppressive drugs even if the transplanted organ is in good function. The team verified whether the patient was familiar with the term “rejection” and explained that a large number of patients (up to 50 %) lose the graft as a result of not taking their immunosuppressive medications properly;

  5. 5.

    To report problems at each clinical visit and to meet the specific interests of each patient;

  6. 6.

    To monitor the compliance with laboratory tests, clinical assessments, and medication supply;

  7. 7.

    To use a non-judgmental approach to discuss adherence;

  8. 8.

    To integrate medication intake with the daily routine;

  9. 9.

    To introduce reminders, such as alarms or digital alerts;

  10. 10.

    To attempt to produce a proactive behavior of the patient toward treatment.

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Garcia, M.F.F.M., Bravin, A.M., Garcia, P.D. et al. Behavioral measures to reduce non-adherence in renal transplant recipients: a prospective randomized controlled trial. Int Urol Nephrol 47, 1899–1905 (2015). https://doi.org/10.1007/s11255-015-1104-z

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  • DOI: https://doi.org/10.1007/s11255-015-1104-z

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