Title

Improving medication adherence and outcomes in adult kidney transplant patients using a personal systems approach: SystemCHANGE™ results of the MAGIC randomized clinical trial.

Creator(s)

Cynthia L. Russell
Donna Hathaway
Laura M. Remy
Dana Aholt
Debra Clark
Courtney Miller
Catherine Ashbaugh
Mark Wakefield
Sangbeak Ye
Vincent S. Staggs, Children's Mercy HospitalFollow
Rebecca J. Ellis
Kathy Goggin, Children's Mercy Kansas CityFollow

Document Type

Article

Publication Date

1-2020

Identifier

DOI: 10.1111/ajt.15528; PMCID: PMC7179766

Abstract

This study determined if a SystemCHANGE™ intervention was more efficacious than attention control in increasing immunosuppressive medication adherence and improving outcomes in adult kidney transplant recipients during a 6-month intervention phase and subsequent 6-month (no intervention) maintenance phase. The SystemCHANGE™ intervention taught patients to use person-level quality improvement strategies to link adherence to established daily routines, environmental cues, and supportive people. Eighty-nine patients (average age 51.8 years, 58% male, 61% African American) completed the 6-month intervention phase. Using an intent-to-treat analysis, at 6 months, medication adherence for SystemCHANGE™ (median 0.91, IQR 0.76-0.96) and attention control (median 0.67, IQR 0.52-0.72) patients differed markedly (difference in medians 0.24, 95% CI 0.13-0.30, P < .001). At the conclusion of the subsequent 6-month maintenance phase, the gap between medication adherence for SystemCHANGE™ (median 0.77, IQR 0.56-0.94) and attention control (median 0.60, IQR 0.44-0.73) patients remained large (difference in medians 0.17, 95% CI 0.06-0.33, P = .004). SystemCHANGE™ patients evidenced lower mean creatinine and BUN at 12 months and more infections at 6 and 12 months. This first fully powered RCT testing SystemCHANGE™ to improve and maintain medication adherence in kidney transplant recipients demonstrated large, clinically meaningful improvements in medication adherence. Clinical Trial Registration: NCT02416479.

Journal Title

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

Volume

20

Issue

1

First Page

125

Last Page

136

Keywords

clinical research/practice; clinical trial; health services and outcomes research; immunosuppressant; immunosuppression/immune modulation; kidney transplantation/nephrology

Comments

Grant support

• R01 DK093592/DK/NIDDK NIH HHS/United States
• T32 NR015426/NR/NINR NIH HHS/United States

Recommended Citation

Russell, C. L., Hathaway, D., Remy, L. M., Aholt, D., Clark, D., Miller, C., Ashbaugh, C., Wakefield, M., Ye, S., Staggs, V. S., Ellis, R. J., Goggin, K. Improving medication adherence and outcomes in adult kidney transplant patients using a personal systems approach: SystemCHANGE™ results of the MAGIC randomized clinical trial. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons 20, 125-136 (2020).