Impact of a pharmaceutical care program on liver transplant patients' compliance with immunosuppressive medication: a prospective, randomized, controlled trial using electronic monitoring.
BACKGROUND
Compliance with immunosuppressive therapy plays a major role in the long-term success of organ transplantation. Thus, strategies to promote compliance in posttransplant care are of particular interest. At the pharmacy department of the University Hospital Mainz, a program for pharmaceutical care of organ transplant patients has been developed for the first time ever. The main objective of the presented study was to examine the influence of this program on liver transplant patients' compliance with immunosuppressive therapy.


METHODS
To measure compliance, medication event monitoring systems were used. Dosing compliance (DC) was calculated for each patient and the mean DC was compared between the two groups. Further direct and indirect methods of measuring compliance served to confirm the electronic compliance data.


RESULTS
Pharmaceutical care of liver transplant patients led to a significant increase in compliance with the immunosuppressive therapy. The mean DC of the intervention group was 90%+/-6% compared with 81%+/-12% in the control group (P=0.015). Only two patients (10%) in the intervention group and nine patients (43%) in the control group showed a DC less than 80% (P=0.032). Furthermore, patients in the intervention group were more likely to achieve target blood levels.


CONCLUSIONS
Patients who received pharmaceutical care with traditional patient care showed significantly better compliance with their immunosuppressive medication than patients who received only traditional patient care. Pharmaceutical care proved to be an effective intervention that should be implemented in posttransplant care.
Klein
Anja
A
Department of Pharmacy, University Hospital Mainz, Langenbeckstrasse, Mainz, Germany. an.klein@gmx.de
Otto
Gerd
G
Krämer
Irene
I
D001007:Anxiety / Q000453:epidemiology; D002214:Capsules / Q000008:administration & dosage; D016572:Cyclosporine / Q000627:therapeutic use; D003863:Depression / Q000453:epidemiology; D004359:Drug Therapy, Combination; D004582:Electronics, Medical / Q000706:statistics & numerical data; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000276:immunology* / Q000523:psychology*; D008297:Male; D018670:Monitoring, Ambulatory / Q000379:methods; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010349:Patient Compliance; D011446:Prospective Studies; D016559:Tacrolimus / Q000627:therapeutic use
D002214:Capsules; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D016559:Tacrolimus