title: Nephrologists' management of patient medications in kidney transplantation: results of an online survey.
abstract: OBJECTIVE
  Medication adherence is essential in kidney transplant recipients to reduce the risk of rejection and subsequent allograft loss. The aim of this study was to delineate what 'usual care' entails, in relation to medication management, for adult kidney transplant recipients.
  
  
  METHODS
  An online survey was developed to explore how nephrologists promote and assess medication adherence, the management of prescriptions, the frequency of clinic appointments and the frequency of clinical screening tests. Nephrologists from all acute kidney transplant units in Victoria, Australia, were invited to participate. Data were collected between May and June 2014.
  
  
  RESULTS
  Of 60 nephrologists invited to participate, 22 completed the survey (response rate of 36.6%). Respondents had a mean age of 49.1 ± 10.1 years, with a mean of 20.1 ± 9.9 years working in nephrology and 14 were men. Descriptive analysis of responses showed that nephrologists performed frequent screening for kidney graft dysfunction that may indicate medication non-adherence, maintained regular transplant clinic visits with patients and emphasized the importance of medication education. However, time constraints during consultations impacted on extensive patient education and the long-term medication follow-up support was often delivered by the renal transplant nurse coordinator or pharmacist.
  
  
  CONCLUSIONS
  This study highlighted that nephrologists took an active approach in the medication management of kidney transplant recipients, which may assist with facilitating long-term graft survival. Ultimately, promoting medication adherence needs to be patient centred, involving an interdisciplinary team of nephrologists, pharmacists and renal transplant nurse coordinators, working together with the patient to establish optimal adherence.
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Crawford
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
authors.forename: Jac Kee
authors.initials: JK
authors.lastname: Low
authors.affiliation: School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia.|The Royal Melbourne Hospital, Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.|Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Manias
authors.affiliation: Alfred Hospital, Melbourne, Victoria, Australia.|Monash University, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Rowan
authors.initials: R
authors.lastname: Walker
authors.affiliation: Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.|Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Nigel D
authors.initials: ND
authors.lastname: Toussaint
authors.affiliation: Nephrology Department, Monash Medical Centre, Clayton, Victoria, Australia.|Department of Medicine, Monash University, Clayton, Victoria, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Mulley
authors.affiliation: Pharmacy Department, Alfred Hospital, Melbourne, Victoria, Australia.|Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Clayton, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Dooley
authors.affiliation: Nephrology Department, Austin Health, Heidelberg, Victoria, Australia.
authors.forename: Francesco L
authors.initials: FL
authors.lastname: Ierino
authors.affiliation: Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Hughes
authors.affiliation: Nephrology Department, St Vincent's Hospital, Melbourne, Victoria, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Goodman
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Williams
mesh_terms: D000328:Adult; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D020407:Internet; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D009819:Office Visits / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000458:organization & administration; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055031:Primary Graft Dysfunction / Q000175:diagnosis; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014739:Victoria; D016903:Drug Monitoring
keywords: health care; kidney transplantation; medication adherence; person-centred medicine