Featured Publication in Journal of Pediatric Transplantation: Bethany J. Foster
The CDTRP is happy to highlight the paper entitled “Care processes and structures associated with higher medication adherence in adolescent and young adult transplant recipients” that was published in Journal of Pediatric Transplantation featuring CDTRP investigators Bethany J. Foster, Ruth Sapir-Pichhadze, Héloïse Cardinal, Tom Blydt-Hansen, Lee Anne Tibbles, Lorraine Hamiwka, Simon Urschel, Patricia Birk, Jennifer Harrison, Veronique Phan, Upton Allen and Seema Mital. Our Research Manager, Katie Bain, asked Bethany a few questions about it:
How do you think the research will advance the field?
This is the first study to include pediatric and adult centres and capture differences in care processes and structures between the two. We have identified features of care delivery that support better adherence so this info could be used to optimize care to improve adherence. Interventions would be simple.
How did the CDTRP contribute to initiating this work?
CDTRP funded this work. This was one of the original 6 projects. It would not have happened without the CDTRP.
Background: We aimed to identify care processes and structures that were independently associated with higher medication adherence among young transplant recipients.
Methods: We conducted a prospective, observational cohort study of 270 prevalent kidney, liver, and heart transplant recipients 14-25 years old. Patients were ≥3 months post-transplant, ≥2 months post-discharge, and followed in one of 14 pediatric or 14 adult transplant programs in Canada. Patients were enrolled between June 2015 and March 2018 and followed for 6 months. Adherence was assessed at baseline, 3, and 6 months using the BAASIS© self-report tool. Patients were classified as adherent if no doses were missed in the prior 4 weeks. Transplant program directors and nurses completed questionnaires regarding care organization and processes.
Results: Of the 270 participants, 99 were followed in pediatric programs and 171 in adult programs. Median age was 20.3 years, and median time since transplant was 5 years. At baseline, 71.5% were adherent. Multivariable mixed effects logistic regression models with program as a random effect identified two program-level factors as independently associated with better adherence: minimum number of prescribed blood draws per year for those >3 years post-transplant (per 1 additional) (OR 1.12 [95% CI 1.00, 1.26]; p = .047), and average time nurses spend with patients in clinic (per 5 additional minutes) (OR 1.15 [1.03, 1.29]; p = .017).
Conclusion: Program-level factors including protocols with a greater frequency of routine blood testing and more nurse time with patients were associated with better medication adherence. This suggests that interventions at the program level may support better adherence.
About Journal of Pediatric Transplantation
Pediatric Transplantation is the only journal devoted to transplantation in infants, children and adolescents. The journal aims to advance science and practice of transplantation in children worldwide, by providing a forum that highlights the most recent advances in clinical and basic science related to this field.