Taking immunosuppressive medications effectively (TIMELink): a pilot randomized controlled trial in adult kidney transplant recipients

Russell, Cynthia L.; Conn, Vicki S.; Ashbaugh, Catherine; Madsen, Richard; Wakefield, Mark R.; Webb, Andrew W.; Coffey, Deanna; Peace, Leanne

doi:10.1111/j.1399-0012.2010.01358.x

Cited by 75 publications

(95 citation statements)

References 28 publications

(46 reference statements)

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“…Therefore, effective, evidence-based intervention strategies are needed to promote long-term IST adherence in RTRs, which in turn results in improved graft survival and may impact other outcomes such as decreased healthcare utilizations and costs. However, previous studies of interventions targeting IST adherence among adult RTRs have produced inconsistent results and have not assessed outcomes linked to adherence such as healthcare utilizations and costs (6)(7)(8)(9). The current RCT is the first study to address this gap in the knowledge base through examination of the effects of a behavioral contract intervention on IST adherence and healthcare utilizations in an adult RTR sample.…”

Section: Discussionmentioning

confidence: 99%

“…Existing studies are hampered by ineffective interventions and/or lack of examination of outcomes related to adherence such as healthcare utilizations and costs, which were found to be associated with decreased IST adherence levels in a retrospective cohort study by Pinsky et al (2,(6)(7)(8)(9). Given the limits of prior published interventional studies, prospective research is needed to evaluate the effects of interventions on IST adherence and healthcare outcomes among adult RTRs.…”

Section: Introductionmentioning

confidence: 99%

“…A search of PubMed (years unlimited) revealed few published studies of interventions targeting IST adherence among adult RTRs (5)(6)(7)(8)(9). Existing studies are hampered by ineffective interventions and/or lack of examination of outcomes related to adherence such as healthcare utilizations and costs, which were found to be associated with decreased IST adherence levels in a retrospective cohort study by Pinsky et al (2,(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

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Improving Outcomes of Renal Transplant Recipients With Behavioral Adherence Contracts: A Randomized Controlled Trial

Chisholm-Burns

Spivey

Zivin

et al. 2013

American Journal of Transplantation

103

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The objective of this randomized controlled trial was to assess the effects of a 1-year behavioral contract intervention on immunosuppressant therapy (IST) adherence and healthcare utilizations and costs among adult renal transplant recipients (RTRs). The sample included adult RTRs who were at least 1 year posttransplant, taking tacrolimus or cyclosporine and served by a specialty pharmacy. Pharmacy refill records were used to measure adherence and monthly questionnaires were used to measure healthcare utilizations. Direct medical costs were estimated using the 2009 Medicare Expenditure Panel Survey. Adherence was analyzed using the GLM procedure and the MIXED procedure of SAS. Rate ratios and 95% confidence intervals were estimated to quantify the rate of utilizing healthcare services relative to treatment assignment. One hundred fifty RTRs were enrolled in the study. Intervention group RTRs (n ¼ 76) had higher adherence than control group RTRs (n ¼ 74) over the study period (p < 0.01). And 76.1% of the intervention group compared with 42.7% of the control group was not hospitalized during the 1-year study period (RR ¼ 1.785; 95% CI: 1.314, 2.425), resulting in cost savings. Thus, evidence supports using behavioral contracts as an effective adherence intervention that may improve healthcare outcomes and lower costs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Improving Outcomes of Renal Transplant Recipients With Behavioral Adherence Contracts: A Randomized Controlled Trial

Chisholm-Burns

Spivey

Zivin

et al. 2013

American Journal of Transplantation

103

View full text Add to dashboard Cite

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“…Since sample size affects studies' statistical power, the effect intervention studies that are not fully powered may not be adequately tested or realized [32] . Though the study by Russell et al (2010) was not powered to detect a difference between groups, the study did find a statistically significant difference between the groups, which supports the large effect size of the CSI personal improvement intervention. The study by Matteson et al (2011) had a small sample size and was not adequately powered to find a statistically significant difference; however, the study found a large effect size.…”

Section: Discussionmentioning

confidence: 56%

“…Russell et al (2010) found the CSI intervention was effective immediately, which indicates that providers may be able to deliver it brief patient encounters. Matteson et al (2011) found with a single dose of CSI delivered in the clinical setting had a very large effect size.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of continuous self-improvement interventions

Matteson

Russell²

2013

Clinical Nursing Studies

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Although health care providers advise healthy and chronically ill adults to adopt positive health behaviors, traditional interventions focused on motivation and intention have been largely ineffective. Researchers have tested the ability of continuous self-improvement (CSI), an innovative personal system-based intervention, to affect health behavior change at the individual level. This paper systematically reviews CSI interventions focused on improving health behaviors. A search of multiple databases was performed using 'continuous self-improvement' as the search term. Abstracts of identified studies were reviewed to determine if CSI was used as an intervention-regardless of sample size, study type, or language. This review identified nine studies testing the CSI intervention in healthy or chronically ill adults. Effect sizes for the two randomized controlled trials were large. CSI shows promise as an effective intervention across a broad age range for a variety of difficult-to-change behaviors. Future research should address methodologic weaknesses.

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Electronic Medication Packaging Devices and Medication Adherence

Checchi

Huybrechts

Avorn

et al. 2014

JAMA

172

126

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Importance Medication non-adherence, which has been estimated to affect 28-31% of US patients with hypertension, hyperlipidemia, and diabetes, may be improved by electronic medication packaging (EMP) devices. Objective To investigate whether EMP devices are associated with improved adherence and to identify and describe common features of EMP devices. Evidence Acquisition We systematically reviewed peer-reviewed studies testing the effectiveness of EMP systems in the MEDLINE, EMBASE, PsycINFO, CINAHL, and International Pharmaceutical Abstracts databases from searches conducted to June 13, 2014. We extracted the associations between the interventions and adherence, as well as other key findings. We assessed each study for bias using the Cochrane Handbook for Systematic Reviews of Interventions. We qualitatively assessed features of EMP devices and interventions. Results 37 studies (32 randomized and 5 non-randomized) including 4,326 patients met review criteria: 10 patient-interface-only “simple” interventions and 29 “complex” interventions integrated into the health care system (2 qualified for both categories). Overall, the effect estimates for mean adherence ranged from -2.9 to 34.0% and the effect estimates for the proportion of patients defined as adherent ranged from -8.0 to 49.5%. We identified 5 common EMP characteristics: recording dosing events and storing a record of adherence, audiovisual reminders to cue dosing, digital displays, real-time monitoring, and providing patients with adherence performance feedback. Conclusion and Relevance Many varieties of EMP exist. However, data supporting their use are limited, with variability in the quality of studies testing EMP devices and evidence of reporting bias. Devices that are integrated into the care delivery system and that are designed to record dosing events are most frequently associated with improved adherence. Higher quality evidence is needed to determine the effect, if any, of these low cost interventions on medication nonadherence and to identify their most useful components.

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Taking immunosuppressive medications effectively (TIMELink): a pilot randomized controlled trial in adult kidney transplant recipients

Abstract: Background-Immunosuppressive medication non-adherence is one of the most prevalent but preventable causes of poor outcomes in adult renal transplant recipients, yet there is a paucity of studies testing interventions in this area.

Cited by 75 publications

References 28 publications

Improving Outcomes of Renal Transplant Recipients With Behavioral Adherence Contracts: A Randomized Controlled Trial

Improving Outcomes of Renal Transplant Recipients With Behavioral Adherence Contracts: A Randomized Controlled Trial

Systematic review of continuous self-improvement interventions

Electronic Medication Packaging Devices and Medication Adherence

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