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Improving medication adherence and outcomes in adult kidney transplant patients using a personal systems approach: SystemCHANGE™ results of the MAGIC randomized clinical trial
Author(s) -
Russell Cynthia L.,
Hathaway Donna,
Remy Laura M.,
Aholt Dana,
Clark Debra,
Miller Courtney,
Ashbaugh Catherine,
Wakefield Mark,
Ye Sangbeak,
Staggs Vincent S.,
Ellis Rebecca J.,
Goggin Kathy
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15528
Subject(s) - medicine , kidney transplant , medication adherence , randomized controlled trial , magic (telescope) , intensive care medicine , kidney transplantation , kidney , physics , quantum mechanics
This study determined if a System CHANGE ™ intervention was more efficacious than attention control in increasing immunosuppressive medication adherence and improving outcomes in adult kidney transplant recipients during a 6‐month intervention phase and subsequent 6‐month (no intervention) maintenance phase. The System CHANGE ™ intervention taught patients to use person‐level quality improvement strategies to link adherence to established daily routines, environmental cues, and supportive people. Eighty‐nine patients (average age 51.8 years, 58% male, 61% African American) completed the 6‐month intervention phase. Using an intent‐to‐treat analysis, at 6 months, medication adherence for System CHANGE ™ (median 0.91, IQR 0.76‐0.96) and attention control (median 0.67, IQR 0.52‐0.72) patients differed markedly (difference in medians 0.24, 95% CI 0.13‐0.30, P < .001). At the conclusion of the subsequent 6‐month maintenance phase, the gap between medication adherence for System CHANGE ™ (median 0.77, IQR 0.56‐0.94) and attention control (median 0.60, IQR 0.44‐0.73) patients remained large (difference in medians 0.17, 95% CI 0.06‐0.33, P = .004). System CHANGE ™ patients evidenced lower mean creatinine and BUN at 12 months and more infections at 6 and 12 months. This first fully powered RCT testing System CHANGE ™ to improve and maintain medication adherence in kidney transplant recipients demonstrated large, clinically meaningful improvements in medication adherence. Clinical Trial Registration: NCT 02416479.