Assessing barriers to adherence in routine clinical care for pediatric kidney transplant patients

Area of Science:

• Nephrology
• Transplantation
• Adherence Research

Background:

• Patient-identified barriers to immunosuppressive medications are linked to poor adherence and adverse clinical outcomes in transplant recipients.
• Routine assessment of adherence barriers is not standard in post-transplant care, with limited studies on reliable implementation strategies.

Purpose of the Study:

• To implement and evaluate a system for identifying adherence barriers in pediatric kidney transplant patients.
• To assess the feasibility and reliability of a patient-centered barriers assessment tool within routine clinical care.

Main Methods:

• Utilized the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles for system implementation.
• Developed a patient-centered assessment tool, integrated into an Electronic Health Record (EHR) via tablet, with automated eligibility alerts.
• Conducted time-series analysis for process measures and examined patient-caregiver dyad concordance on barriers.

Main Results:

• The EHR-integrated tablet system proved to be the most reliable delivery method for barrier assessment.
• Adherence barriers were reported by 43% of patients (forgetting, taste, side effects) and 35% of caregivers (forgetting, side effects).
• Fair concordance (k=0.299) was observed between patient and caregiver reports of barriers.

Conclusions:

• Standardized assessment of adherence barriers is feasible in pediatric kidney transplant care.
• Successful implementation requires automation, redundant systems, dedicated staff, clear reporting, and reliable measurement.
• Future research will investigate the predictive value of identified barriers on clinical outcomes like organ rejection and graft loss.