Video Education and Behavior Contract to Improve Outcomes After Renal Transplantation (VECTOR): A Randomized Controlled Trial

IF 2 3区医学 Q2 MEDICINE, GENERAL & INTERNAL

Patient preference and adherence Pub Date : 2024-07-31 DOI:10.2147/ppa.s467142

Holly Mansell, Nicola Rosaasen, Jenny Wichart, Patricia West-Thielke, David Blackburn, Juxin Liu, Rahul Mainra, Ahmed Shoker, Brianna Groot, Kevin Wen, Anita Wong, Bita Bateni, Cindy Luo, Paraag Trivedi

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引用次数: 0

Abstract

Abstract: Sub-optimal adherence to immunosuppressant medications reduces graft survival for kidney transplant recipients and adherence-enhancing interventions are resource and time intensive. We performed a multi-center randomized controlled trial to investigate the impact of an electronically delivered intervention on adherence. Of 203 adult kidney transplant recipients who received a de novo kidney transplant n = 173 agreed to participate (intent-to-treat population) and were randomized to the intervention (video education plus behavior contract n = 91) or the control (standard education, n = 82). No significant differences were found between the groups for medication adherence measured by the Basel Assessment of Adherence to Immunosuppressive Medications Scale, intrapatient variability in tacrolimus levels, time in therapeutic range for any immunosuppressant, knowledge, self-efficacy, QOL, or hospitalizations. Among a subgroup of 64 participants randomized to the intervention group who completed a post-intervention questionnaire, two-thirds (67%, n = 43) reported watching at least 80% of the videos and 58% (n = 37) completed the electronic goal setting exercise and adherence contract. An autonomous goal setting exercise and electronic behavioural contract added to standard of care did not improve any outcomes. Our findings reiterate that nonadherence in transplantation is a difficult multifactorial problem that simple solutions will not solve. Trial registration number NCT03540121.

Keywords: kidney transplant, solid organ transplant, medication adherence, immunosuppression

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改善肾移植术后疗效的视频教育和行为契约 (VECTOR)：随机对照试验

摘要：免疫抑制药物的依从性不达标会降低肾移植受者的移植物存活率，而提高依从性的干预措施需要耗费大量的资源和时间。我们进行了一项多中心随机对照试验，研究电子干预对依从性的影响。在 203 名接受了新肾移植的成人肾移植受者中，有 173 人同意参与（意向治疗人群），他们被随机分配到干预组（视频教育加行为合同，91 人）或对照组（标准教育，82 人）。通过巴塞尔免疫抑制剂用药依从性评估量表（Basel Assessment of Adherence to Immunosuppressive Medications Scale）测量的用药依从性、患者间他克莫司水平的变异性、任何免疫抑制剂在治疗范围内的时间、知识、自我效能、QOL或住院情况在两组间没有发现明显差异。在随机加入干预组并完成干预后问卷调查的 64 名参与者中，三分之二（67%，n = 43）的人表示至少观看了 80% 的视频，58%（n = 37）的人完成了电子目标设定练习和坚持治疗合同。在标准护理的基础上增加自主目标设定练习和电子行为契约并未改善任何结果。我们的研究结果再次表明，移植中的不依从性是一个棘手的多因素问题，简单的解决方案无法解决这一问题。试验注册号：NCT03540121.关键词：肾移植、实体器官移植、用药依从性、免疫抑制

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来源期刊

Patient preference and adherence MEDICINE, GENERAL & INTERNAL-

CiteScore

3.60

自引率

4.50%

发文量

354

审稿时长

6-12 weeks

期刊介绍： Patient Preference and Adherence is an international, peer reviewed, open access journal that focuses on the growing importance of patient preference and adherence throughout the therapeutic continuum. The journal is characterized by the rapid reporting of reviews, original research, modeling and clinical studies across all therapeutic areas. Patient satisfaction, acceptability, quality of life, compliance, persistence and their role in developing new therapeutic modalities and compounds to optimize clinical outcomes for existing disease states are major areas of interest for the journal. As of 1st April 2019, Patient Preference and Adherence will no longer consider meta-analyses for publication.