title: A Pilot Randomized Controlled Trial to Promote Immunosuppressant Adherence in Adult Kidney Transplant Recipients.
abstract: BACKGROUND
  Nonadherence to immunosuppressant medication is a prevalent practice among kidney transplant recipients and has been associated with increased risk for graft failure and economic burden. The aim of this pilot study was to test whether a culturally sensitive cognitive-behavioral adherence promotion program could significantly improve medication adherence to tacrolimus prescription as measured by telephone pill counts among kidney transplant recipients.
  
  
  METHODS
  Thirty-three adult transplant recipients were less than 98% adherent to tacrolimus prescription based on 3 telephone pill counts and were randomized either to the 2-session cognitive-behavioral adherence promotion program or to standard care. The curriculum was developed from an iterative process with transplant recipients into a 2-session group program that provided psychoeducation, addressed barriers to adherence, fostered motivation to improve adherence behavior, and discussed cultural messages on adherence behavior.
  
  
  RESULTS
  The intervention group displayed significantly higher levels of adherence when compared to the control group (t = 2.2, p = 0.04) and. similarly, when the amount of change was compared between the groups, the intervention group showed more change than the control condition (F (22,1) = 12.005, p = 0.003). Tacrolimus trough concentration levels were used as a secondary measure of adherence and, while there were no significant between-group differences for mean trough concentration levels, the variability in the trough levels did significantly decrease over time indicating more consistent pill-taking behavior in the intervention group.
  
  
  CONCLUSIONS
  There is preliminary support for the pilot program as a successful intervention in helping patients with their immunosuppressant medication.
authors.affiliation: Department of Psychiatry and Behavioral Science, SUNY Downstate Medical Center,Brooklyn, N.Y., USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cukor
authors.forename: Nisha
authors.initials: N
authors.lastname: Ver Halen
authors.forename: Melissa
authors.initials: M
authors.lastname: Pencille
authors.forename: Fasika
authors.initials: F
authors.lastname: Tedla
authors.forename: Moro
authors.initials: M
authors.lastname: Salifu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000627:therapeutic use*; D007407:Interviews as Topic / Q000379:methods; D016030:Kidney Transplantation / Q000523:psychology; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010865:Pilot Projects; D016559:Tacrolimus / Q000097:blood / Q000627:therapeutic use; D066027:Transplant Recipients / Q000523:psychology
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus