Cukor Daniel, Ver Halen Nisha, Pencille Melissa, Tedla Fasika, Salifu Moro
Department of Psychiatry and Behavioral Science, SUNY Downstate Medical Center,Brooklyn, N.Y., USA.
Nephron. 2017;135(1):6-14. doi: 10.1159/000448627. Epub 2016 Sep 7.
Nonadherence to immunosuppressant medication is a prevalent practice among kidney transplant recipients and has been associated with increased risk for graft failure and economic burden. The aim of this pilot study was to test whether a culturally sensitive cognitive-behavioral adherence promotion program could significantly improve medication adherence to tacrolimus prescription as measured by telephone pill counts among kidney transplant recipients.
Thirty-three adult transplant recipients were less than 98% adherent to tacrolimus prescription based on 3 telephone pill counts and were randomized either to the 2-session cognitive-behavioral adherence promotion program or to standard care. The curriculum was developed from an iterative process with transplant recipients into a 2-session group program that provided psychoeducation, addressed barriers to adherence, fostered motivation to improve adherence behavior, and discussed cultural messages on adherence behavior.
The intervention group displayed significantly higher levels of adherence when compared to the control group (t = 2.2, p = 0.04) and. similarly, when the amount of change was compared between the groups, the intervention group showed more change than the control condition (F (22,1) = 12.005, p = 0.003). Tacrolimus trough concentration levels were used as a secondary measure of adherence and, while there were no significant between-group differences for mean trough concentration levels, the variability in the trough levels did significantly decrease over time indicating more consistent pill-taking behavior in the intervention group.
There is preliminary support for the pilot program as a successful intervention in helping patients with their immunosuppressant medication.
肾移植受者中不遵医嘱服用免疫抑制剂的情况很普遍，且与移植失败风险增加和经济负担相关。这项试点研究的目的是测试一项具有文化敏感性的认知行为依从性促进计划，是否能通过电话清点药丸数量来显著提高肾移植受者对他克莫司处方的药物依从性。
根据3次电话清点药丸数量，33名成年移植受者对他克莫司处方的依从率低于98%，他们被随机分为两组，一组接受为期两节课的认知行为依从性促进计划，另一组接受标准护理。该课程是通过与移植受者反复沟通，开发出的一个为期两节课的小组计划，提供心理教育，解决依从性障碍，激发改善依从行为的动机，并讨论关于依从行为的文化信息。
与对照组相比，干预组的依从性水平显著更高（t = 2.2，p = 0.04），同样，当比较两组之间的变化量时，干预组的变化比对照组更大（F(22,1) = 12.005，p = 0.003）。他克莫司谷浓度水平被用作依从性的次要衡量指标，虽然两组之间的平均谷浓度水平没有显著差异，但随着时间的推移，谷浓度水平的变异性确实显著降低，这表明干预组的服药行为更加一致。
该试点计划作为一项成功的干预措施，在帮助患者服用免疫抑制剂方面得到了初步支持。
