title: Intensified pharmaceutical care is improving immunosuppressive medication adherence in kidney transplant recipients during the first post-transplant year: a quasi-experimental study.
abstract: BACKGROUND
  Medication adherence is critical for transplant patients because the consequences of non-adherence can result in allograft loss and may be life threatening.
  
  
  METHODS
  A prospective study with 74 renal transplant recipients using a sequential control group design was performed to investigate the impact of a pharmaceutical intensified care programme led by a clinical pharmacist on daily drug adherence during the first year after renal transplantation. Thirty-nine patients of the control group received the already established standardized drug and transplant training, while 35 patients of the intensified care group (ICG) received additional inpatient and outpatient pharmaceutical care and counselling by a dedicated clinical pharmacist. Applied interventions were clustered and classified using the behaviour change technique taxonomy according to Michie. Adherence to immunosuppressive drug therapy was monitored up to 1 year using a medication event monitoring system, pill count (PC), drug holiday (DH) occurrence, Morisky questionnaire and self-report.
  
  
  RESULTS
  Sixty-seven patients (35 of the standard care and 32 of the ICG) were analysed. Implementation of DA was significantly (P = 0.014) improved in patients of the ICG (91%) compared with SCG (75%) during the first year after transplantion. Daily adherence measures were already improved within 30-40 days after start of intensified patient care and continued throughout the study period. Intensified care patients also showed significantly better results for taking adherence (P = 0.006), PC (P = 0.008) and DHs (P = 0.001).
  
  
  CONCLUSIONS
  The additional, intensified pharmaceutical care improved patients' medication adherence remarkably, suggesting that the applied additional care programme has the potential to improve outcomes after organ transplantation.
authors.affiliation: Pharmacy Department, Erlangen University Hospital, Erlangen, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Joost
authors.affiliation: Pharmacy Department, Erlangen University Hospital, Erlangen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Dörje
authors.affiliation: Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nürnberg (FAU), Erlangen, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Schwitulla
authors.affiliation: Department of Nephrology and Hypertension, University of Erlangen-Nürnberg (FAU), Erlangen, Germany.
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Eckardt
authors.affiliation: Medizinische Klinik III, Bereich Nephrologie, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Hugo
mesh_terms: D064591:Allografts; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010353:Patient Education as Topic; D010593:Pharmaceutical Services / Q000592:standards*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: electronic monitoring; kidney transplantation; medication adherence; patient education; pharmaceutical care