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Assessing barriers to adherence in routine clinical care for pediatric kidney transplant patients
Author(s) -
Varnell Charles D.,
Rich Kristin L.,
Nichols Melissa,
Dahale Devesh,
Goebel Jens W.,
Pai Ahna L. H.,
Hooper David K.,
Modi Avani C.
Publication year - 2017
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13027
Subject(s) - medicine , concordance , forgetting , intensive care medicine , medline , patient safety , health care , philosophy , linguistics , political science , law , economics , economic growth
Abstract Patient‐identified barriers to immunosuppressive medications are associated with poor adherence and negative clinical outcomes in transplant patients. Assessment of adherence barriers is not part of routine post‐transplant care, and studies regarding implementing such a process in a reliable way are lacking. Using the Model for Improvement and PDSA cycles, we implemented a system to identify adherence barriers, including patient‐centered design of a barriers assessment tool, identification of eligible patients, clear roles for clinic staff, and creating a culture of non‐judgmental discussion around adherence. We performed time‐series analysis of our process measure. Secondary analyses examined the endorsement and concordance of adherence barriers between patient‐caregiver dyads. After three methods of testing, the most reliable delivery system was an EHR‐integrated tablet that alerted staff of patient eligibility for assessment. Barriers were endorsed by 35% of caregivers (n=85) and 43% of patients (n=60). The most frequently patient‐endorsed barriers were forgetting, poor taste, and side effects. Caregivers endorsed forgetting and side effects. Concordance between patient‐caregiver dyads was fair (k=0.299). Standardized adherence barriers assessment is feasible in the clinical care of pediatric kidney transplant patients. Features necessary for success included automation, redundant systems with designated staff to identify and mitigate failures, aligned reporting structures, and reliable measurement approaches. Future studies will examine whether barriers predict clinical outcomes (eg, organ rejection, graft loss).