부산대학교 도서관

This study determined if a SystemCHANGE™ intervention was more efficacious than attention control in increasing immunosuppressive medication adherence and improving outcomes in adult kidney transplant recipients during a 6‐month intervention phase and subsequent 6‐month (no intervention) maintenance phase. The SystemCHANGE™ intervention taught patients to use person‐level quality improvement strategies to link adherence to established daily routines, environmental cues, and supportive people. Eighty‐nine patients (average age 51.8 years, 58% male, 61% African American) completed the 6‐month intervention phase. Using an intent‐to‐treat analysis, at 6 months, medication adherence for SystemCHANGE™ (median 0.91, IQR0.76‐0.96) and attention control (median 0.67, IQR0.52‐0.72) patients differed markedly (difference in medians 0.24, 95% CI0.13‐0.30, P< .001). At the conclusion of the subsequent 6‐month maintenance phase, the gap between medication adherence for SystemCHANGE™ (median 0.77, IQR0.56‐0.94) and attention control (median 0.60, IQR0.44‐0.73) patients remained large (difference in medians 0.17, 95% CI0.06‐0.33, P= .004). SystemCHANGE™ patients evidenced lower mean creatinine and BUNat 12 months and more infections at 6 and 12 months. This first fully powered RCTtesting SystemCHANGE™ to improve and maintain medication adherence in kidney transplant recipients demonstrated large, clinically meaningful improvements in medication adherence. Clinical Trial Registration: NCT02416479. This randomized controlled trial demonstrates the efficacy of a novel intervention in achieving clinically meaningful improvement in immunosuppressive medication adherence in adult kidney transplant patients who were medication nonadherent. See Foster's commentary on page 5.