SystemCHANGE: An RCT for Medication Adherence in Adult Kidney Transplant Recipients With kidney transplant (KT) recipients as our exemplar population, our goal is to develop and test interventions that increase medication adherence in chronically ill adults. Among adult KT recipients, non-adherence to immunosuppressive medications (MNA) is the leading predictor of poor outcomes, including rejection, kidney loss, and death. An alarming one-third of KT patients experience MNA even though the problem is preventable. Adherence intervention studies have proven marginally effective for those with acute and chronic illnesses and ineffective for adult KT recipients. Using a randomized controlled trial design with an attention- control group, this R01 will test an innovative 6-month SystemCHANGE intervention to enhance immunosuppressive medication adherence in adult non-adherent KT recipients. This intervention shows great promise for increasing adherence with a large effect size of 1.4 in our pilot study. Grounded in the socio- ecological model, SystemCHANGE seeks to systematically improve medication adherence behaviors by identifying and shaping routines, involving supportive others in routines, and using medication taking feedback through small patient-lead experiments to change and maintain behavior. Medication adherence will be measured by electronic monitoring. Medication adherence persistence will be examined by evaluating the difference between the two groups during the 6-month maintenance phase. Mediators and moderators of medication adherence will be examined. Health outcomes will be compared and a cost-effectiveness analysis will be conducted.

Public Health Relevance

The results of this proposed work will inform all healthcare providers since it is estimated that 50% of patients do not take their prescribed medications. The intervention is not disease-specific, so other chronic illnesses requiring extensive self-management, such as diabetes mellitus and cardiovascular disease, may also benefit from this study's results. The findings have the potential to improve desirable health outcomes and decrease healthcare costs. This is exciting, innovative work that has significant potential to move forward medication adherence interventions which have remained largely ineffective for the last 35 years.

Agency
National Institute of Health (NIH)
Type
Research Project (R01)
Project #
1R01DK093592-01A1
Application #
8694408
Study Section
Nursing and Related Clinical Sciences Study Section (NRCS)
Program Officer
Narva, Andrew
Project Start
Project End
Budget Start
Budget End
Support Year
1
Fiscal Year
2014
Total Cost
Indirect Cost
Name
University of Missouri Kansas City
Department
None
Type
Schools of Nursing
DUNS #
City
Kansas City
State
MO
Country
United States
Zip Code
64110