Interventions to improve medication adherence in adult kidney transplant recipients: a systematic review

The immune system is a powerful barrier to successful organ transplantation, but one that has been routinely thwarted through modern pharmacotherapeutics. Despite the benefits of immunosuppressive therapy, medication non-adherence leads to an increased risk of graft rejection, higher hospital utilization and costs, and poor outcomes. We conduct a scoping review following Arksey and O’Malley’s five-stage framework methodology to identify established or novel interventions that could be applied to kidney transplant recipients to improve medication adherence. As the desired outcome is a behavior (taking a pill), we assess three areas: behavioral-focused interventions in other industries, patient engagement theories, and behavioral economic principles. Search strategies included mining business, social sciences, and medical literature with additional guidance from six consultative interviews. Our review suggests that no intervention stands out as superior or likely to be more effective than any other intervention; yet promising strategies and interventions were identified across all three areas examined. Based on our findings, we believe there are five strategies that transplant centers and other organizations can implement to improve medication adherence: (1) Build a foundation of trust; (2) Employ multiple interventions; (3) Stratify the population; (4) Develop collaborative partnerships; and (5) Embed medication adherence into the organization’s culture. The effectiveness of these interventions will need to be investigated further, but we believe they are a step in the right direction for organizations to consider in their efforts to improve medication adherence.

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Effect and features of information technology-based interventions on self-management in adolescent and young adult kidney transplant recipients: a systematic review

Adolescent Health Medicine and Therapeutics ◽

10.2147/ahmt.s200801 ◽

2019 ◽

Vol Volume 10 ◽

pp. 173-190 ◽

Cited By ~ 3

Author(s):

Raheleh Ganjali ◽

Farnaz Khoshrounejad ◽

Mohammad Reza Mazaheri Habibi ◽

Zhila Taherzadeh ◽

Reza Golmakani ◽

...

Keyword(s):

Systematic Review ◽

Information Technology ◽

Young Adult ◽

Kidney Transplant ◽

Adolescent And Young Adult ◽

Self Management ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Adult Kidney

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MAGIC Study: Aims, Design and Methods using SystemCHANGE™ to Improve Immunosuppressive Medication Adherence in Adult Kidney Transplant Recipients

BMC Nephrology ◽

10.1186/s12882-016-0285-8 ◽

2016 ◽

Vol 17 (1) ◽

Cited By ~ 11

Author(s):

Cynthia L. Russell ◽

Shirley Moore ◽

Donna Hathaway ◽

An-Lin Cheng ◽

Guoqing Chen ◽

...

Keyword(s):

Medication Adherence ◽

Kidney Transplant ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Immunosuppressive Medication ◽

Adult Kidney ◽

Design And Methods

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Effectiveness of IT-based interventions on self-management in adult kidney transplant recipients: a systematic review

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01360-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Saeid Eslami ◽

Farnaz Khoshrounejad ◽

Reza Golmakani ◽

Zhila Taherzadeh ◽

Fariba Tohidinezhad ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Kidney Transplant ◽

Care Process ◽

Self Management ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Adult Kidney ◽

The Impact ◽

Positive Effect

Abstract Background Kidney transplant outcomes are broadly associated with transplant recipients’ capacity in following a complex and continuous self-management regimen. Health information technology has the potential to empower patients. This systematic review aimed to determine the impacts of IT-based interventions for self-management in kidney transplant recipients. Methods A comprehensive investigation was performed in MEDLINE (via PubMed) and EMBASE (via Scopus) in April 2019. Eligible studies were the randomized controlled trials which aimed to design an automated IT-based intervention. All English papers including adult kidney transplant recipients were included. To assess the clinical trial’s quality, Cochrane Collaboration’s assessment tool was employed. The articles were integrated based on category of outcomes, characteristics of interventions, and their impact. The interventions were classified based on the used IT-based tools, including smart phones, coverage tools, computer systems, and a combination of several tools. The impact of interventions was defined as: (1) positive effect (i.e. statistically significant), and (2) no effect (i.e. not statistically significant). Results A total of 2392 articles were retrieved and eight publications were included for full-text analysis. Interventions include those involving the use of computerized systems (3 studies), smart phone application (3 studies), and multiple components (2 studies). The studies evaluated 30 outcomes in total, including 24 care process and 6 clinical outcomes. In 18 (80%) out of 30 outcomes, interventions had a statistically significant positive effect, 66% in process and 33% in clinical outcomes. Conclusions IT-based interventions (e.g. mobile health applications, wearable devices, and computer systems) can improve self-management in kidney transplant recipients (including clinical and care process outcomes). However, further evaluation studies are required to quantify the impact of IT-based self-management interventions on short- and long-term clinical outcomes as well as health care costs and patients' quality of life.

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