title: Transitioning health care responsibility from caregivers to patient: a pilot study aiming to facilitate medication adherence during this process.
abstract: Transition in pediatric transplant recipients consists of both a physical shift in medical care location as well as a transition in health care responsibilities from caregivers to patients. The purpose of the present study was to test the feasibility of a pilot intervention aiming to facilitate the transition in health care responsibilities from caregivers to patients while patients are still receiving pediatric services. Twenty-two patients were enrolled in a two-session educational protocol aiming to facilitate transition of responsibility. Patients were recruited from an outpatient transplant clinic. Ten were referred because of suspected difficulty in transitioning of care, and 12 were consecutively recruited without any specific a priori concerns. Medication adherence, measured through the use of standard deviations of tacrolimus blood levels, and ALT levels were the medical outcome measures. Complete data are available for 20 patients. Mean ALT levels improved after the follow-up period. For referred patients, adherence and ALT levels improved. Standard deviation of tacrolimus decreased from 3.33 to 2.23, t = 2.52, p = 0.04. Mean ALT decreased from 120.33 to 63.99, t = 3.01, p = 0.01. Maximal ALT values decreased overall from 284.10 to 101.20, t = 2.61, p = 0.03. Our findings suggest that targeted education regarding transition in responsibility for adolescents' own health care is feasible in the outpatient environment and may assist families who are facing this potentially challenging process. A randomized, controlled study with a substantial number of enrolled patients is needed to establish the efficacy of this or other approaches.
authors.affiliation: Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA. rachel.annunziato@mssm.edu
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Annunziato
authors.forename: Sukru
authors.initials: S
authors.lastname: Emre
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Shneider
authors.forename: Christina A
authors.initials: CA
authors.lastname: Dugan
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Aytaman
authors.forename: Mary M
authors.initials: MM
authors.lastname: McKay
authors.forename: Eyal
authors.initials: E
authors.lastname: Shemesh
mesh_terms: D000293:Adolescent; D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism; D002648:Child; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D016377:Organ Transplantation / Q000379:methods*; D010349:Patient Compliance; D010372:Pediatrics; D010865:Pilot Projects; D012646:Self Administration; D016559:Tacrolimus / Q000097:blood / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000410:Alanine Transaminase; D016559:Tacrolimus