Improving Outcomes of Renal Transplant Recipients With Behavioral Adherence Contracts: A Randomized Controlled Trial

• Published in: American journal of transplantation Vol. 13; no. 9; pp. 2364 - 2373
• Main Authors: Chisholm‐Burns, M. A., Spivey, C. A., Graff Zivin, J., Lee, J. K., Sredzinski, E., Tolley, E. A.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Wiley 01-09-2013; Elsevier Limited
• Subjects: Adult; Aged; Behavior modification; Behavior Therapy; Biological and medical sciences; Clinical trials; Confidence intervals; Cost control; Cyclosporine - therapeutic use; Female; Health risk assessment; Health Services - statistics & numerical data; healthcare costs; Humans; Immunosuppressive Agents - administration & dosage; Kidney Transplantation; Male; Medical sciences; Medication Adherence; Middle Aged; Miscellaneous; Patient Compliance - statistics & numerical data; Patients; Public health. Hygiene; Public health. Hygiene-occupational medicine; randomized controlled trial; renal transplant recipients; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tacrolimus - therapeutic use; Transplants & implants; Modification; Costs; Prognosis; renal transplant recipients; Transplantation; medication adherence; Homotransplantation; Kidney; Improvement; Randomization; Surgery; Graft; Clinical trial; Evolution; Treatment compliance; Behavior; Public health; Behavior modification; Adhesion; Randomized controlled trial; Care; healthcare costs; Treatment; Urinary system; Health economy; Healthcare; Contract; randomized controlled trial
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.12341

The objective of this randomized controlled trial was to assess the effects of a 1‐year behavioral contract intervention on immunosuppressant therapy (IST) adherence and healthcare utilizations and costs among adult renal transplant recipients (RTRs). The sample included adult RTRs who were at least 1 year posttransplant, taking tacrolimus or cyclosporine and served by a specialty pharmacy. Pharmacy refill records were used to measure adherence and monthly questionnaires were used to measure healthcare utilizations. Direct medical costs were estimated using the 2009 Medicare Expenditure Panel Survey. Adherence was analyzed using the GLM procedure and the MIXED procedure of SAS. Rate ratios and 95% confidence intervals were estimated to quantify the rate of utilizing healthcare services relative to treatment assignment. One hundred fifty RTRs were enrolled in the study. Intervention group RTRs (n = 76) had higher adherence than control group RTRs (n = 74) over the study period (p < 0.01). And 76.1% of the intervention group compared with 42.7% of the control group was not hospitalized during the 1‐year study period (RR = 1.785; 95% CI: 1.314, 2.425), resulting in cost savings. Thus, evidence supports using behavioral contracts as an effective adherence intervention that may improve healthcare outcomes and lower costs.
A randomized controlled trial of a behavioral contract intervention targeting immunosuppressant therapy adherence finds that renal transplant recipients in the intervention group experienced improved adherence and outcomes compared to those in the control group.