Varnell Charles D, Hooper David K, Mara Constance A, Modi Avani C, Rich Kristin L
Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7022, Cincinnati, OH 45229, USA.
James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Children (Basel). 2023 Aug 23;10(9):1435. doi: 10.3390/children10091435.
Assessing barriers to adherence provides helpful information to clinicians. The objective of this study was to describe the clinical utility of the Barriers Assessment Tool (BAT) using clinical data for a large, midwestern U.S. pediatric kidney transplant program.
Focus group and clinical data were obtained during post-transplant medical visits. Qualitative and quantitative assessment methods were utilized to describe patient and caregiver feedback on the BAT, clinical utility, concordance between reporters, and the effect of interventions on subsequent assessment and electronically measured adherence.
Patients were willing to discuss adherence issues with their care team. There was substantial agreement between patients and caregivers at two timepoints. If a barrier was not addressed, 89.6% (43/48) of patients and 85.9% (67/78) of caregivers reported the same BAT scores from the first to second assessment. When barriers were addressed with a clinic-based intervention, 82% of caregivers reported no adherence barriers. No significant change was found for patient-reported barriers.
Standardized assessment of barriers to medication adherence provides actionable information to clinicians. Standardized assessment of adherence barriers may give clinicians opportunities to help patients and caregivers overcome these barriers which can decrease risk of rejection.
评估依从性障碍可为临床医生提供有用信息。本研究的目的是利用美国中西部一个大型儿科肾移植项目的临床数据，描述障碍评估工具（BAT）的临床实用性。
在移植后医疗就诊期间获取焦点小组和临床数据。采用定性和定量评估方法，描述患者和护理人员对BAT的反馈、临床实用性、报告者之间的一致性，以及干预措施对后续评估和电子测量的依从性的影响。
患者愿意与他们的护理团队讨论依从性问题。在两个时间点，患者和护理人员之间存在高度一致性。如果一个障碍未得到解决，89.6%（43/48）的患者和85.9%（67/78）的护理人员在第一次和第二次评估中报告的BAT分数相同。当通过基于诊所的干预措施解决障碍时，82%的护理人员报告没有依从性障碍。患者报告的障碍没有发现显著变化。
对药物依从性障碍进行标准化评估可为临床医生提供可采取行动的信息。对依从性障碍进行标准化评估可能会给临床医生提供机会，帮助患者和护理人员克服这些障碍，从而降低排斥反应的风险。
