title: Taking immunosuppressive medications effectively (TIMELink): a pilot randomized controlled trial in adult kidney transplant recipients.
abstract: BACKGROUND
  Immunosuppressive medication non-adherence is one of the most prevalent but preventable causes of poor outcomes in adult renal transplant recipients, yet there is a paucity of studies testing interventions in this area.
  
  
  METHODS
  Using a randomized controlled trial design, 30 adult renal transplant recipients were screened for medication non-adherence using electronic monitoring. Fifteen non-adherent participants were randomized to receive either a continuous self-improvement intervention or attention control management. The six-month continuous self-improvement intervention involved the participant and clinical nurse specialist collaboratively identifying the person's life routines, important people, and possible solutions to enhance medication taking. The participant then received individual monthly medication taking feedback delivered via a graphic printout of daily medication taking generated from electronic monitoring.
  
  
  RESULTS
  The mean medication adherence score for the continuous self-improvement intervention group (n = 8) was statistically significantly higher than the attention control group's (n = 5) mean medication adherence score (p = 0.03). The continuous self-improvement intervention effect size (Cohen's d) was large at 1.4. Participants' perceptions of the intervention were highly favorable.
  
  
  CONCLUSIONS
  The continuous self-improvement intervention shows promise as an effective and feasible approach to improve medication adherence in adult renal transplant recipients. A fully-powered study with a diverse sample is needed to confirm these preliminary findings.
authors.affiliation: Sinclair School of Nursing, University of Missouri, Columbia, MO, USA. russellc@missouri.edu
authors.forename: Cynthia
authors.initials: C
authors.lastname: Russell
authors.forename: Vicki
authors.initials: V
authors.lastname: Conn
authors.forename: Catherine
authors.initials: C
authors.lastname: Ashbaugh
authors.forename: Richard
authors.initials: R
authors.lastname: Madsen
authors.forename: Mark
authors.initials: M
authors.lastname: Wakefield
authors.forename: Andrew
authors.initials: A
authors.lastname: Webb
authors.forename: Deanna
authors.initials: D
authors.lastname: Coffey
authors.forename: Leanne
authors.initials: L
authors.lastname: Peace
mesh_terms: D000328:Adult; D018479:Early Intervention, Educational; D005240:Feasibility Studies; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010348:Patient Care Team; D010349:Patient Compliance; D010865:Pilot Projects; D011379:Prognosis
chemical_list: D007166:Immunosuppressive Agents