Jarmo Henriksson1, Gunnar Tydén, Jonas Höijer, Jonas Wadström. 1. 1 Division of Transplant Surgery, Karolinska University Hospital, Huddinge, Stockholm, Sweden. 2 Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND: Outcome after renal transplantation depends on patient compliance and adherence for early detection of complications and identification of intervention opportunities. Compliance describes the degree to which patients follow medical advice and take their medications. Adherence has been defined as the extent to which a patients' behavior coincides with clinical prescriptions. MATERIALS AND METHODS: Patients were randomized 7 to 14 days after transplantation into groups with (n = 40) and without (n = 40) an electronic medication dispenser (EMD). The EMD, which was used for the 1-year study period, recorded the date and time the patient took their medications and was monitored via a web-based application. Patients were monitored for 1 year regarding outpatient follow-up visits, emergency hospitalizations, renal biopsies, rejection episodes, renal function, and blood concentration of medications. RESULTS:Compliance in the intervention group was 97.8% (the control group was not assessed). Number of missed doses varied significantly by weekday (P = 0.033); patients were most likely to miss doses on Saturdays and Thursdays. Patients missed a total of 11 follow-up visits. During the study, 92 biopsies were performed on 55 patients (intervention group: 32 [17]; control group, 60 [38]). Biopsy-verified rejection was three times more common among controls (13 patients vs. 4; P = 0.054, not significant). Average P-creatinine level was slightly lower in the intervention group than the control group (131 vs. 150 μmol/L, not significant), whereas mean tacrolimus was similar (7.32 vs. 7.22 ng/mL, n.s.). CONCLUSIONS: The EMD is associated with high compliance, and there are also indications of a lower rejection rate.
RCT Entities:
BACKGROUND: Outcome after renal transplantation depends on patient compliance and adherence for early detection of complications and identification of intervention opportunities. Compliance describes the degree to which patients follow medical advice and take their medications. Adherence has been defined as the extent to which a patients' behavior coincides with clinical prescriptions. MATERIALS AND METHODS:Patients were randomized 7 to 14 days after transplantation into groups with (n = 40) and without (n = 40) an electronic medication dispenser (EMD). The EMD, which was used for the 1-year study period, recorded the date and time the patient took their medications and was monitored via a web-based application. Patients were monitored for 1 year regarding outpatient follow-up visits, emergency hospitalizations, renal biopsies, rejection episodes, renal function, and blood concentration of medications. RESULTS: Compliance in the intervention group was 97.8% (the control group was not assessed). Number of missed doses varied significantly by weekday (P = 0.033); patients were most likely to miss doses on Saturdays and Thursdays. Patients missed a total of 11 follow-up visits. During the study, 92 biopsies were performed on 55 patients (intervention group: 32 [17]; control group, 60 [38]). Biopsy-verified rejection was three times more common among controls (13 patients vs. 4; P = 0.054, not significant). Average P-creatinine level was slightly lower in the intervention group than the control group (131 vs. 150 μmol/L, not significant), whereas mean tacrolimus was similar (7.32 vs. 7.22 ng/mL, n.s.). CONCLUSIONS: The EMD is associated with high compliance, and there are also indications of a lower rejection rate.
Authors: Jessica K Stevenson; Zoe C Campbell; Angela C Webster; Clara K Chow; Allison Tong; Jonathan C Craig; Katrina L Campbell; Vincent Ws Lee Journal: Cochrane Database Syst Rev Date: 2019-08-06
Authors: Larissa Myaskovsky; Michelle T Jesse; Kristin Kuntz; Abbie D Leino; John Devin Peipert; Cynthia L Russell; Christina A Spivey; Nimisha Sulejmani; Mary Amanda Dew Journal: Clin Transplant Date: 2018-08-09 Impact factor: 2.863
Authors: Lisa Mellon; Frank Doyle; Anne Hickey; Kenneth D Ward; Declan G de Freitas; P Aiden McCormick; Oisin O'Connell; Peter Conlon Journal: Cochrane Database Syst Rev Date: 2022-09-12
Authors: Xue Li; Zhaohua Huo; Zongshan Hu; Tsz Ping Lam; Jack Chun Yiu Cheng; Vincent Chi-Ho Chung; Benjamin Hon Kei Yip Journal: PLoS One Date: 2022-07-20 Impact factor: 3.752