Associations of characteristics of renal transplant recipients with clinicians' perceptions of adherence to immunosuppressant therapy.

Background: The objective of the study was to determine surveillance criteria for renal transplant recipients (RTRs) at highest risk for immunosuppressant therapy nonadherence.

Methods: Retrospective analyses were performed on follow-up data in the United States Renal Data System. Those who received transplants between January 1, 1995 and December 31, 2002, had at least 36 months of follow-up data, and did not receive a second renal transplant were included in the analyses.

Effects of a medication assistance program with medication therapy management on the health of renal transplant recipients.

Purpose: The effects of a medication assistance program with medication therapy management (MTM) on the clinical outcomes and health-related quality of life (HQOL) of renal transplant recipients were studied.

Methods: All renal transplant recipients who were enrolled in the Medication Access Program at the Medical College of Georgia for at least one year were included in the study. Patients' demographics, number of graft rejections (for one year pre-enrollment and one year post-enrollment), and diagnoses of hypertension, diabetes, and dyslipidemia were recorded and confirmed by medical and pharmacy records.

Predicting adherence to immunosuppressant therapy: a prospective analysis of the theory of planned behaviour.

Background: The objective of this study was to increase the ability to predict renal transplant patients (RTPs) who are most likely to be non-adherent to their immunosuppressant therapy (IST).

Methods: One hundred and fifty-eight RTPs completed questionnaires assessing Theory of Planned Behaviour (TPB) variables (attitudes, subjective norms and perceived behavioural control) relevant to intentions to adhere to their IST, with the addition of a general measure of past adherence to medical advice. In the full sample, intentions to adhere to IST was the outcome variable.

Influence of economic and demographic factors on quality of life in renal transplant recipients.

Background: The purpose of this study was to determine the influence of annual income, Medicare status, and demographic variables on the health-related quality of life (HQoL) of renal transplant recipients.

Methods: A cross-sectional survey was mailed to 146 Georgia renal transplant recipients who had functional grafts. Data were collected using the SF-12 Health Survey (version 2), a demographics survey, and 2003 tax documents.

Is age associated with the number or types of medications prescribed to renal transplant recipients?

Objectives: To determine whether age influences the number or types of medications prescribed to younger (aged 18-64) and elderly (aged > or =65) renal transplant recipients 3 years posttransplant.

Design: A cross-sectional study involving renal transplant recipients.

Setting: Medical College of Georgia.

Development of an instrument to measure professionalism.

Objectives: To develop and validate an instrument that measures professionalism among pharmacy students and recent graduates.

Methods: A pharmacy professionalism survey instrument developed by a focus group was pretested and then administered to all first-year pharmacy students enrolled in the University of Georgia College of Pharmacy and to recent pharmacy graduates who were taking the preparation course for the Georgia Pharmacy Law Examination and North American Pharmacist Licensure Examination. Participants were asked to indicate the extent to which they agreed or disagreed with each of 32 items using a 5-point Likert scale.

A renal transplantation advanced pharmacy practice experience.

Objectives: To establish and evaluate an ambulatory care renal transplantation clinic advanced pharmacy practice experience (APPE).

Design: Students spend 5 weeks performing pharmaceutical care activities for renal transplant patients, presenting health-related topics, and conducting research. A paired t test was used to determine differences between students' pre- and post-APPE test scores.

Modified-release tacrolimus.

Objective: To review the pharmacokinetics, efficacy, adverse effects, and clinical trials of modified-release tacrolimus (MR-4) concerning its equivalence to non-modified-release tacrolimus.

Data Sources: A PubMed/MEDLINE search was conducted (1966-July 2005) using the following terms: MR-4, tacrolimus, FK506, Prograf, transplantation, calcineurin inhibitors, and immunosuppression. Additional data sources included meeting abstracts, bibliographies from identified publications, and information from the manufacturer.

Development and validation of the immunosuppressant therapy adherence instrument (ITAS).

A five-item scale was developed that asked respondents to indicate how often they were non-adherent to immunosuppressant therapy (IST) given a particular circumstance. Two hundred and twenty-two recipients completed the instrument. Validity of the scale was assessed by correlating composite item scores with refill record adherence rates (RRARs), serum immunosuppressant (IS) concentrations, graft rejection, and increased serum creatinine (SCr) levels.

Patient factors associated with adherence to immunosuppressant therapy in renal transplant recipients.

Purpose: Factors associated with adherence to immunosuppressant therapy (IST) in renal transplant recipients were studied.

Methods: The Immunosuppressant Therapy Adherence Scale (ITAS) was completed by adult renal transplant recipients in Georgia. Those completing the ITAS were classified as adherent to IST if their ITAS score were 12 and nonadherent if their score was less than 12.

Medicare-approved drug discount cards and prescription drug prices.

Purpose: Prescription drug prices with and without the use of Medicare-approved drug discount card programs (MADDCs) to purchase medications were studied.

Methods: The Medicare.gov Web site was used to determine if the 200 most frequently prescribed drugs in the United States in 2003 were covered by a MADDC.

Medicare-approved drug discount cards and renal transplant patients: how much can these cards reduce prescription costs?

Background: Post-transplant prescription medications are expensive, often costing over 12,000 dollars annually. Many solid-organ transplant patients have Medicare coverage and patients enrolled in Medicare-approved drug discount card (MADDC) programs may be able to receive prescription medications at a reduced price. However, many transplant healthcare practitioners are unaware of the utility of MADDCs.

Comparing renal transplant patients' adherence to free cyclosporine and free tacrolimus immunosuppressant therapy.

Background: The purpose of this study is to determine if there is a difference in renal transplant patients' (RTPs) adherence to cyclosporine compared to tacrolimus when medications are supplied free to the RTPs.

Methods: Adult primary RTPs were included in the study if they received a renal transplant at the Medical College of Georgia (MCG) from June 1998 through August 2001 and received their first post-transplant year of follow-up care at MCG and free cyclosporine or free tacrolimus from the MCG outpatient pharmacy. Adherence was estimated by comparing each RTPs' tacrolimus or cyclosporine pharmacy refill records to the prescribed regimen for 12 months after transplant.

Development and validation of an immunosuppressant therapy adherence barrier instrument.

Background: To decrease allograft rejection as a result of non-adherence to immunosuppressant therapy (IST), a valid and reliable instrument that measures solid organ transplant patients' adherence barriers is needed.

Methods: An immunosuppressant therapy barrier scale (ITBS) was developed to assess transplant patients' perceived barriers to IST adherence and was completed by 222 transplant patients who lived in Georgia, USA. A renal transplant population subset was used to test the ITBS reliability and validity.

Identification of medication-adherence barriers and strategies to increase adherence in recipients of renal transplants.

One hundred randomly selected renal transplant centers (RTCs) were surveyed concerning barriers to medication adherence by recipents of renal transplants (RTRs). Responders were asked to list factors that they believe decrease RTRs' medication adherence. Survey responses were used to develop another survey, which was mailed to a different set of 100 RTCs.

Effect of clinical pharmacy services on the blood pressure of African-American renal transplant patients.

Objective: The objective of this study was to determine if African-American renal transplant patients who received direct patient care from a clinical pharmacist had better blood pressure control compared to African-American renal transplant patients who did not have clinical pharmacy services.

Methods: Renal transplant patients were prospectively randomized into an intervention group or a control group. Patients in the intervention group received clinical pharmacy services that included a clinical pharmacist performing patient medication reviews, with emphasis on preventing or resolving medication-related problems and providing medication recommendations.

Enhancing transplant patients' adherence to medication therapy.

Despite the importance of proper medication use, many transplant patients do not take their medications correctly. Non-adherence to medication therapy leads to adverse consequences, and practitioners should encourage adherence by transplant patients. This manuscript discusses several aspects of medication taking behavior including: (1) methods of identifying medication non-adherence; (2) models used to identify possible determinants of medication taking behavior; (3) strategies to educate patients concerning their therapy; (4) factors promoting adherence and non-adherence; and (5) practical interventions that we, as practitioners, can employ to enhance adult and pediatric transplant patients' adherence to therapy.

Pharmaceutical manufacturer assistance programs.

Background And Objective: While there have been many public discussions concerning Medicare covering outpatient prescription medications, currently, Medicare does not pay for most outpatient prescriptions. Meanwhile, costs associated with prescription medications as well as the number of underinsured patients are rapidly increasing. Many pharmaceutical companies offer assistance programs for patients who require medications but have inadequate financial resources to obtain them.

Issues of adherence to immunosuppressant therapy after solid-organ transplantation.

Nonadherence to immunosuppressant therapy constitutes a major barrier to post-transplant care. Failure of transplant recipients to take prescribed drugs properly may not only be a significant obstacle to optimal graft function but it may also result in decreased quality of life and productivity, increased morbidity and healthcare cost, and death. Despite the obvious importance of adherence to immunosuppressant therapy, nonadherence is frequent among transplant recipients, with rates ranging from 2 to 68%.