Improving medication adherence in adult kidney transplantation (IMAKT): A pilot randomised controlled trial

• Published in: Scientific reports Vol. 9; no. 1; p. 7734
• Main Authors: Low, Jac Kee, Manias, Elizabeth, Crawford, Kimberley, Walker, Rowan, Mulley, William R, Toussaint, Nigel D, Dooley, Michael, Kennedy, Elaine, Smith, Catherine L, Nalder, Michelle, Yip, Doris, Williams, Allison
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 22.05.2019; Nature Publishing Group UK; Nature Portfolio
• Subjects: Adult; Audiovisual Aids; Counseling; Female; Graft Rejection - prevention & control; Hospitals, Public; Humans; Immunosuppressive Agents - therapeutic use; Kidney Transplantation; Kidney transplants; Male; Medication Adherence; Microelectromechanical systems; Middle Aged; Patient compliance; Patient Education as Topic; Pilot Projects; Single-Blind Method; Tacrolimus - therapeutic use; Telemedicine; Telephone; Transplants & implants; Treatment Outcome; Victoria; Victoria
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-019-44002-y

Resources to support long-term medication adherence in kidney transplantation are limited. This study aimed to determine the efficacy of an intervention designed for kidney transplant recipients to enhance medication adherence. A single-blind, multi-site, 12-month pilot randomised controlled trial was conducted at all five public hospitals providing adult kidney transplantation in Victoria, Australia. Participants were recruited at 4 to 6 weeks post-transplantation. Thirty-five participants were randomly assigned to a 3-month intervention, involving a face-to-face meeting (a medication review and a consumer-centred video) and health coaching every two weeks. Thirty-six were randomised to receive usual care. All participants were followed for nine months post-intervention. There were no differences in adherence between groups measured by Medication Event Monitoring System (MEMS), however, it was underutilised by 42% of participants. Based on the self-reported Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS©) score, the percentage of adherent participants decreased significantly between baseline and 3 to 12 months in the control group (p-values < 0.001) whilst the percentage of adherent participants in the intervention group remained constant over time. No group differences were detected in other outcomes. Due to the complex medication regimen, developing and testing a medication adherence intervention is difficult in kidney transplantation.