About 75 percent of kidney transplant recipients fail to properly take the medications they need to stay healthy, says Cynthia Russell, a professor at the University of Missouri – Kansas City School of Nursing and Health Studies.
After receiving a transplant, patients - many of whom previously needed kidney dialysis – typically feel healthy and often simply forget to take medications as needed twice a day.
“They are active. They are feeling good. They are just living normal lives,” Russell says.
Although patients usually do not have significant problems with medication side effects, a consistent regimen of immunosuppressant medications is required to keep the body’s immune system at bay. Without it, the immune system may attack and reject the transplanted organ as a foreign body.
Patients need to take immunosuppressant medications for the life of the transplant. The median lifespan is 11 to 12 years; some last beyond 30 years.
The average age of kidney transplant recipients is 50 and the majority are diabetic.
Russell acknowledges that patients’ failure to take vital medication vexes many health providers, who need to monitor their progress closely after a transplant.
“It is frustrating,” she says.
UMKC nursing school gets $2.6 million grant
The National Institutes of Health recently awarded UMKC’s School of Nursing and Health Studies nearly $2.6 million to look at how to keep adult kidney transplant recipients on their medication. (KCUR is licensed by UMKC.) Russell, who also serves as president of the International Transplant Nurses Society, is the primary investigator on the grant.
Since 2010, Russell has been working with a behavior-change intervention approach called SystemCHANGE, which has been used to encourage exercise and weight loss, among other uses.
Russell’s plan calls for health providers to conduct six-month interventions with transplant patients to encourage better medication adherence.
Patients will adopt small modifications to improve the regularity with which they take medications. A microchip inside the medication container then monitors their progress.
“The chip records the date and time they remove the cap,” she says. “And we then presume that they’ve taken their medication.”
The information is sent to the health provider, who prepares monthly reports for the patient. The provider and patient then work together to make monthly adjustments as needed to improve adherence.
Avoiding blame
Russell says that when presented with the data, patients are often surprised by their performance.
“They would often say, ‘I really thought I was doing a lot better than this,’” she says.
Russell's program, however, seeks to avoid affixing blame.
“When you talk to someone about what they’re not doing, it typically makes them very defensive. They don’t want to talk about it. They shut down and the communication stops,” she says.
Russell was previously awarded an NIH grant to study how transplant patients take medications without intervention.
The new grant will fund a four-year study that will also explore how ethnicity, perceived health and social support affect adherence.
Once proven effective, intervention changes typically take about 17 years to be implemented. Russell hopes her program will be adopted more quickly.
She plans to apply for another NIH grant in the future to study implementation.
