Can structured counselling and adherence tools improve adherence to immunosuppressive therapy in renal transplant patients?

Abstract

Optimal adherence to immunosuppressants in renal transplant patients is vital for the survival of the transplanted kidney. Pharmacists are in an ideal position to counsel and support patients on adherence to medication and should be actively involved in the multidisciplinary healthcare team providing patient care, specifically medication taking. The aim of this study was to assess whether a pharmacist-led adherence enhancing intervention involving structured counselling and providing adherence tools such as diary cards and pillboxes, improved adherence to immunosuppressive therapy in renal transplant patients. This was an open label randomised controlled study. 49 renal transplant patients were recruited from the specialised surgery outpatient clinic and transplant ward at Steve Biko Academic Hospital (known then as Pretoria Academic hospital). Patients were randomly assigned to either the intervention or the control group. The intervention group received an average of thirty minutes counselling about their medication from the study pharmacist as well as an adherence pack containing adherence tools. Patients in the intervention group were randomly allocated pillboxes. The control patients received the standard level of care that was normally provided at Steve Biko Academic Hospital in Pretoria, South Africa. At each repeat prescription and scheduled clinic visit patients from both the intervention and the control group received their medication and were interviewed by the study pharmacist. If the study pharmacist identified any problems with adherence in the patients in the intervention group further counselling, advice and support was given to the patient. Patients were followed up for either six months or six visits from their initial visit. Immunosuppressant medications as well as other chronic medications were monitored during the study. Data was collected using questionnaires. A clinician also assessed each patient’s clinical condition at the end of the study to ascertain whether or not it had improved or declined over the period of the study. The data was analysed quantitatively. No significant difference was found between the mean adherence of the intervention and the control groups. However, 85% of study participants indicated that the pharmacist made a difference to the way they took their medication, and 95% of those patients indicated that the pharmacist had made a positive impact on the way they took their medication, 98% of study participants indicated that they were satisfied with the patient care they received and over half the study participants (66%) indicated that they wanted to receive support and advice from a pharmacist at every prescription dispensing visit. Overall the intervention received positive feedback from the participants. This study indicates the need for further research into this area especially in the measurement of adherence. New more accurate methods for measuring adherence are required. Improving adherence to immunosuppressants in renal transplant patients could be improved by evaluating patient’s adherence before transplant to identify any barriers to adherence, and providing a combination of individually tailored interventions over a sustained period of time. The pharmacist’s role could also be improved by educating pharmacists at undergraduate level about the importance of adherence and including it in the training of all aspects of patient care, and providing information and support via continuing education to pharmacists already working in the profession. Copyright