Computerised Pill-Taking Reports Significantly Improve Adherence Among Noncompliant Transplant Recipients: Presented at ATC

By Cathy Yarbrough

SAN DIEGO -- May 5, 2010 -- Adult renal transplant recipients significantly improved their medication adherence during a continuous self-improvement intervention in which the patients regularly received computer printouts showing the timing and frequency of their daily pill taking. The findings from the randomised controlled pilot study were presented here at the 2010 American Transplant Congress (ATC).

The study, the first to evaluate this continuous self-improvement intervention approach, provided transplant recipients with monthly feedback, including the computer printout of the patients' medication habits as recorded by electronic medication caps on the patients' pill bottles.

The study focused on older patients because 73% of kidney transplant patients older than 65 years of age do not adhere to their prescribed immunosuppressive drug regimen, lead author Cynthia L. Russell, RN, PhD, University of Missouri Health Care, Columbia, Missouri, reported May 2. Dr. Russell noted that since 2000, renal transplantation in this age group has increased by 80%

The continuous self-improvement intervention, which also was characterised by the clinical nurse specialist and transplant recipient collaboratively identifying possible ways to enhance the patient's medication compliance, was compared with the attention-control intervention, in which the clinical nurse specialist provided attentive listening and support to the patient.

At 1 month, the mean medication adherence score for the continuous self-improvement intervention group was significantly higher than the attention-control group's mean medication adherence score (P = .03). The continuous self-improvement intervention effect size (Cohen's d) was large at 1.4.

At 6 months, medication adherence remained relatively stable in the continuous self-improvement group, said Dr. Russell, who plans to conduct a fully powered study.

Participating in the study were patients previously shown to be noncompliant with their medications. Their pill taking had been tracked by the Medication Event Monitoring System (MEMS) computer chips that recorded each time they removed their pill bottle caps.

Using the database created from information downloaded from the MEMS pill bottle caps, the researchers screened a convenience sample of 30 adult renal transplant recipients to identify nonadherent patients to participate in the study. The selected study participants were then assigned to receive either the continuous self-improvement intervention or the attention-control intervention, both for 6 months.

The MEMS technology allowed the researchers to track the medication-taking patterns of both groups.

A total of 15 participants completed the study. Their mean age was 51 years.

While historical research on medicine-taking habits varies widely, previous studies have indicated that about 25% of renal transplant patients do not take their anti-rejection prescriptions on time, said Dr. Russell.

Researchers have not yet determined the impact of medication noncompliance on organ rejection. About 12% of patients must undergo a second kidney transplant because their initial organs are rejected.

[Presentation title: A Pilot RCT to Increase Medication Adherence in Transplantation. Abstract 1168]