An interventional study of Pharmacist led medication adherence interventions in Medication Adherence and Kidney Transplantation, sponsored by Imperial College London. Completed at 1 site in United Kingdom. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2024-12-05.
Sponsored by Imperial College London · Not applicable, Interventional, and Prevention
Organs for transplantation remain a scarce and precious resource with over 5000 patients currently on the kidney transplant waiting list. A kidney transplant costs approximately £17,000 in the first year and £5,000 per subsequent year. If the transplant fails, the patient must return to dialysis at an estimated cost of £30,800 per year or be retransplanted. While short term outcomes have improved steadily over the last 15-20 years, longer term outcomes haven't and after 10 years approximately 30% of kidney transplants have failed. Nonadherence to immunosuppressive medication is increasingly being associated with these poor long term outcomes and studies have estimated that 30- 50% of transplant patients are nonadherent to their immunosuppressive medication. The investigators want to determine whether immunosuppression medication adherence can be improved in a group of patients receiving tailored medication adherence support form a pharmacist. Adherence support will be provided for one year and will be individualised to each patient in the intervention group after identifying both their practical and perceptual barriers to adherence. The adherence interventions offered may include additional education and medication counselling, setting alarms, provision of a medication list, the use of a medications adherence app on a smart phone, reducing the number and frequency of tablets a patient takes or referral on to another health professional such as a social worker or psychologist for additional support. A range of clinical outcomes will be assessed for all patients on a regular basis in order to determine whether the provision of effective medication adherence support for the kidney transplant patients may help to optimise the long-term outcomes of these transplants
This study will be undertaken using a prospective, multidimensional design. 42 nonadherent kidney transplant patients will be included in the intervention group. The nonadherent patients will be identified through Imperial College Renal and Transplant Centre (ICRTC) Outpatient Clinic based at Hammersmith Hospital. Standard and transplant specific demographics will be collected for all patients. All kidney transplant patients have their tacrolimus levels measured at each clinic visit. The variability of these levels can be used as a marker of their adherence. Patients with a high intrapatient variability (IPV) of their levels are said to be nonadherent. The Chief Investigator or another member of the research team will approach individual patients directly in the transplant out-patient clinic where they are members of the multidisciplinary clinical care team. The Chief Investigator or another member of the research team may also telephone patients to invite them to clinic to discuss participation in the trial. The Chief Investigator or another member of the research team will describe the study to the patient, answer any questions they have and provide them with a participant information sheet (PIS). Patients will be given the opportunity to take the PIS away and think about whether they would like to participate. A follow up discussion either in clinic or on the phone will be arranged with the patient to answer any queries they have within two weeks of providing them with the PIS; during that discussion, the Chief Investigator or other member of the research team will arrange an appointment in the transplant clinic with the patient to sign the consent form if they do decide to participate. Patients recruited into the study will receive pharmacist led, patient tailored interventions to improve immunosuppressant medication adherence. Patients will be included in the study for one year from recruitment.
The pharmacist led, patient tailored intervention will involve regular, intensive, personalised support from a pharmacist to improve adherence to immunosuppressive medications. The pharmacist will meet with the patient on a regular basis in the transplant clinic to identify their perceptual and practical barriers to adherence and agree a support plan that is tailored to them.
Within the first two weeks of recruitment, the study pharmacist will meet with the patient in transplant clinic to:
This first visit will provide a baseline assessment of the patient's medication adherence.
Tailored support may include:
The structure of each follow up adherence review will be the same as the first formal adherence review with the exception that the BMQ will only be repeated at the end of the one year follow-up and the socioeconomic and educational assessment will only be undertaken at the first assessment review. Every patient will have a formal adherence assessment at recruitment and then at 3, 6, 9 and 12 months. At the end of one year of follow-up, the specific benefits perceived by the patient of intensive adherence support from a pharmacist will be determined through a questionnaire.
Baseline nonadherence will be measured at the first visit with the study pharmacist within two weeks of recruitment and then at 3, 6, 9 and 12 months. The IPV of their tacrolimus levels and their outpatient clinic nonattendance rate will be measured retrospectively in the 12 months prior to recruitment to the study and then prospectively at the end of the intervention year. The IPV is calculated from the tacrolimus levels measured for an individual patient using the coefficient of variance mathematical formula - Coefficient of variance (COV) defined as: SD x 100 / Mean. The outpatient clinic nonattendance for each participant will be taken from the hospital integrated computer system.
Imperial College London is the lead sponsor of 824 studies on the registry; 178 are open to participants now.
Of its 9 completed or terminated interventional studies of FDA-regulated products, 6 (67%) have results posted.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Pharmacist led medication adherence interventions which will be tailored to individual patient need
Behavioral: Pharmacist led medication adherence interventions
Medication adherence interventions which will be tailored to individual patient need
Change in Number of Patients Being Adherent/Non-aherent After the Intervention
Immunosuppression Medication adherence will be assessed and compared using the BAASIS questionnaire at recruitment and at the end of the study. The BAASIS questionnaire is a closed question questionnaire (either adherent or non-adherent); it is validated for assessing immunosuppression nonadherence in transplant patients. Any patient answering yes to any of the questions is assessed to be nonadherent
Time frame: One year
Change in the Median IPV Before and After the Intervention
Intrapatient variability of tacrolimus levels will be measured and compared and reported as percentage difference
Time frame: One year
Change in Outpatient Clinic Nonattendance Rate Before and After the Intervention
Data for this outcome measure has not been analysed: originally the outpatient clinic nonattendance rate was to be assessed and compared during the 12 months prior to recruitment to the study and during the study
Time frame: One year
Biopsy Proven ACR / AMR
Number of patients who develop biopsy proven ACR/AMR
Time frame: One year
The Number of Readmissions
The number of readmissions and their reasons why during the study will be recorded
Time frame: One year
Donor Specific Antibody (DSA) or Transplant Glomerulopathy
For secondary outcome measures 6\&7 - no one developed a Donor Specific Antibody (DSA) or Transplant Glomerulopathy, Fibrosis, Hyalinosis, Calcineurin Inhibitor (CNI) Toxicity or Diabetic Change. Number of patients who develop a DSA or transplant glomerulopathy (CNI) toxicity or diabetic change on biopsy
Time frame: One year
Fibrosis, Hyalinosis, Calcineurin Inhibitor (CNI) Toxicity or Diabetic Change on Toxicity
For secondary outcome measures 6\&7 - No biopsies were indicated throughout the study therefore no one developed Fibrosis, Hyalinosis, Calcineurin Inhibitor (CNI) Toxicity or Diabetic Change Number of patients who develop fibrosis, hyalinosis, calcineurin inhibitor
Time frame: One year
Graft Loss
Number of patients who lose their graft
Time frame: One year
Death
Number of patients who die
Time frame: One year
Serum Creatinine
Change in serum creatinine at the end of the study Data for this outcome measure has not been analysed
Time frame: One year
eGFR
Change in eGFR at the end of the study. Data for this outcome measure has not been analysed
Time frame: One year
Proteinuria
Change in proteinuria at the end of the study. Data for this outcome measure has not been analysed
Time frame: One year
Haematocrit
Change in haematocrit at the end of the study. Data for this outcome measure has not been analysed
Time frame: One year
Haemoglobin
Change in haemoglobin at the end of the study. Data for this outcome measure has not been analysed
Time frame: One year
Albumin
Change in albumin at the end of the study. Data for this outcome measure has not been analysed
Time frame: One year
| Milestone | Medication Adherence Interventions |
|---|---|
| Started | 42 |
| Completed | 42 |
| Not completed | 0 |
Immunosuppression Medication adherence will be assessed and compared using the BAASIS questionnaire at recruitment and at the end of the study. The BAASIS questionnaire is a closed question questionnaire (either adherent or non-adherent); it is validated for assessing immunosuppression nonadherence in transplant patients. Any patient answering yes to any of the questions is assessed to be nonadherent
| Participants | Medication Adherence Interventions |
|---|---|
| Adherent (Time 0) | 15 |
| Adherent (Time 3 months) | 30 |
| Adherent (Time 6 months) | 34 |
| Adherent (Time 9 months) | 35 |
| Adherent (Time 12 months) | 36 |
Intrapatient variability of tacrolimus levels will be measured and compared and reported as percentage difference
| % difference | Medication Adherence Interventions |
|---|---|
| Change in the Median IPV Before and After the Intervention | 32.03 (-22.61 to 80.83) |
Data for this outcome measure has not been analysed: originally the outpatient clinic nonattendance rate was to be assessed and compared during the 12 months prior to recruitment to the study and during the study
No measurements were reported for this outcome.
Number of patients who develop biopsy proven ACR/AMR
| Participants | Medication Adherence Interventions |
|---|---|
| Biopsy Proven ACR / AMR | 0 |
The number of readmissions and their reasons why during the study will be recorded
| Participants | Medication Adherence Interventions |
|---|---|
| Number of readmissions associated with the study | 0 |
| Number of patients who had readmissions | 12 |
| Number of patients who didn't have readmissions | 30 |
For secondary outcome measures 6\&7 - no one developed a Donor Specific Antibody (DSA) or Transplant Glomerulopathy, Fibrosis, Hyalinosis, Calcineurin Inhibitor (CNI) Toxicity or Diabetic Change. Number of patients who develop a DSA or transplant glomerulopathy (CNI) toxicity or diabetic change on biopsy
| number of interventions | Medication Adherence Interventions |
|---|---|
| Donor Specific Antibody (DSA) or Transplant Glomerulopathy | 0 |
For secondary outcome measures 6\&7 - No biopsies were indicated throughout the study therefore no one developed Fibrosis, Hyalinosis, Calcineurin Inhibitor (CNI) Toxicity or Diabetic Change Number of patients who develop fibrosis, hyalinosis, calcineurin inhibitor
| number of interventions | Medication Adherence Interventions |
|---|---|
| Fibrosis, Hyalinosis, Calcineurin Inhibitor (CNI) Toxicity or Diabetic Change on Toxicity | 0 |
Number of patients who lose their graft
| Participants | Medication Adherence Interventions |
|---|---|
| Graft Loss | 0 |
Number of patients who die
| Participants | Medication Adherence Interventions |
|---|---|
| Death | 0 |
Change in serum creatinine at the end of the study Data for this outcome measure has not been analysed
Results for this outcome have not been posted.
Change in eGFR at the end of the study. Data for this outcome measure has not been analysed
Results for this outcome have not been posted.
Change in proteinuria at the end of the study. Data for this outcome measure has not been analysed
Results for this outcome have not been posted.
Change in haematocrit at the end of the study. Data for this outcome measure has not been analysed
Results for this outcome have not been posted.
Change in haemoglobin at the end of the study. Data for this outcome measure has not been analysed
Results for this outcome have not been posted.
Change in albumin at the end of the study. Data for this outcome measure has not been analysed
Results for this outcome have not been posted.
Collected over 1 yr circa. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Medication Adherence Interventions | 0/42 (0%) | 14/42 (33.3%) | 38/42 (90.5%) |
| Event | Medication Adherence Interventions |
|---|---|
| Infection - Tx kidneyRenal and urinary disorders | 2/42 |
| Infection - native kidneyRenal and urinary disorders | 2/42 |
| Infection - chestRespiratory, thoracic and mediastinal disorders | 2/42 |
| Elective SurgerySurgical and medical procedures | 2/42 |
| Infection - Tx gynaeReproductive system and breast disorders | 1/42 |
| Infection - colecystisGastrointestinal disorders | 1/42 |
| ITPVascular disorders | 1/42 |
| NODATMetabolism and nutrition disorders | 1/42 |
| Pain - Ostheopatic fracture spineMusculoskeletal and connective tissue disorders | 1/42 |
| Angioedema and hyponatraemiaVascular disorders | 1/42 |
| Event | Medication Adherence Interventions |
|---|---|
| Infection - colecystitisRenal and urinary disorders | 1/42 |
| Infection - EBVInfections and infestations | 1/42 |
| Infection - COVID (loss of sense of taste and smell)Infections and infestations | 1/42 |
| VomitingGastrointestinal disorders | 1/42 |
| Pain - hip and knee painMusculoskeletal and connective tissue disorders | 1/42 |
| Pain - generalised aches and painsMusculoskeletal and connective tissue disorders | 1/42 |
| Pain - herniaGastrointestinal disorders | 1/42 |
| Swollen hand - possible goutGeneral disorders | 1/42 |
| FallGeneral disorders | 1/42 |
| NODAT - new diagnosisSurgical and medical procedures | 1/42 |
| Age, Customized(years) | Medication Adherence Interventions |
|---|---|
| Age at Transplant | 52.27 (43.89 to 60.65) |
| Age at Recruitment | 58.45 (49.84 to 67.06) |
| Sex: Female, Male(Participants) | Medication Adherence Interventions |
|---|---|
| Female | 14 |
| Male | 28 |
| Race/Ethnicity, Customized(Participants) | Medication Adherence Interventions |
|---|---|
| Black | 13 |
| Caucasian | 18 |
| Indoasian | 9 |
| Other | 2 |
| Region of Enrollment(participants) | Medication Adherence Interventions |
|---|---|
| United Kingdom | 42 |
| Marital Status(Participants) | Medication Adherence Interventions |
|---|---|
| Cohabiting | 2 |
| Divorced | 4 |
| Married | 27 |
| Single | 7 |
| Widowed | 2 |
| Education Status(Participants) | Medication Adherence Interventions |
|---|---|
| A levels/B Tec | 11 |
| Degree | 11 |
| GCSE / O Levels | 12 |
| Higher Degree | 2 |
| No Qualification | 6 |
| Graft Type(Participants) | Medication Adherence Interventions |
|---|---|
| Living Donor | 22 |
| Deceased Donor | 20 |
| Dialysis Modality(Participants) | Medication Adherence Interventions |
|---|---|
| HD | 26 |
| PD | 2 |
| Pre-emptive | 14 |
2 further baseline measures are reported on the registry.
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