Implementing a Process to Systematically Identify and Address Poor Medication Adherence in Pediatric Liver Transplant...

Area of Science:

• Pediatric transplantation
• Immunosuppression therapy
• Quality improvement in healthcare

Background:

• Medication adherence is critical for pediatric liver transplant recipients.
• Poor adherence affects up to 50% of adolescent liver transplant patients.
• System-level interventions are promising for addressing adherence challenges.

Purpose of the Study:

• To implement a system for identifying and addressing medication adherence barriers in pediatric liver transplant patients.
• To improve patient outcomes through enhanced adherence.

Main Methods:

• Utilized structured quality improvement methods and plan-do-study-act cycles.
• Developed a system to screen for adherence risks and identify patient/caregiver-reported barriers.
• Tracked outcomes including tacrolimus trough level variability and acute cellular rejection episodes.

Main Results:

• The system was implemented with high reliability (>90% of patients received interventions).
• The most common barrier reported by patients and caregivers was "forgetting."
• Other key barriers included medication interference with activities (patients) and difficulty swallowing pills (caregivers).

Conclusions:

• Challenges and opportunities exist in screening for and addressing immunosuppression adherence barriers.
• Patient-centered, barrier-specific interventions are crucial.
• Improving medication adherence can enhance long-term graft survival.