Predictors and Intervention for Noncompliance

不合规的预测因素和干预

• 批准号: 6682455
• 负责人: Thomas E Nevins
• 金额: $ 12.4万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-04-01 至 2008-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6682455
• 关键词: artificial immunosuppression; behavior prediction; clinical research; clinical trials; dialysis therapy; drug administration rate /duration; epidemiology; human subject; human therapy evaluation; kidney transplantation; outcomes research; patient oriented research; statistics /biometry; therapy compliance; transplant rejection

Medication noncompliance is a serious, but under-investigated problem in solid organ transplantation. This project takes advantage of electronic medication monitoring to obtain dynamic records of medication compliance after renal transplantation. This proposal will: expand studies of the natural history of post-transplant compliance in relation to discrete outcomes (acute rejection, graft loss, or death); continue a randomized study of intensive intervention to improve post-transplant compliance; and begin the examination of pre-transplant behaviors and psychological attributes predicting acute rejection, graft loss, or death. Aim 1 - In a prospective cohort of 134 renal transplants, who have completed 4 years of monitored medication compliance, the association of noncompliance with chronic graft dysfunction will be further investigated. The role of medication noncompliance and "drug holidays" in triggering late, acute transplant rejection will be more completely elucidated. Aim 2 - 195 renal transplant patients are enrolled in a prospective intervention study aimed at improving medication compliance. "High-risk" patients, with declining compliance, were randomized to intensive intervention or standard care. This study will continue to recruit patients and use discrete outcomes (acute rejection, graft loss, or death) to test intervention efficacy. Aim 3 - A prospective study of 250 pre-transplant dialysis patients will monitor their medical compliance and measure behavioral characteristics while receiving dialysis therapy. Post-transplant, medication monitoring will continue, and patients will be followed for acute rejection, graft loss, or death. Identifying specific pre-transplant factors associated with post-transplant behaviors and outcomes may result in new strategies for pre-transplant interventions which could improve outcomes for both dialysis and renal transplant patients.

药物不合规是一个严重的，但在固体器官中被调查的问题不足 移植。该项目利用电子药物监测来获得 肾移植后药物合规性的动态记录。该建议将：扩展 研究后移植后依从性的自然历史与离散结果有关 （急性拒绝，移植损失或死亡）；继续对密集干预的随机研究 提高移植后的合规性；并开始检查移植前行为和 心理属性可以预测急性排斥，移植物损失或死亡。目标1- 预期的134次肾脏移植术，已经完成了4年的监测药物依从性，不遵守慢性移植功能障碍的关联将得到进一步研究。药物不符合性和“药物假期”在触发晚期，急性移植排斥反应中的作用将更加完全阐明。 AIM 2-195肾移植患者参加了一项旨在改善药物依从性的前瞻性干预研究。 “高风险”患者的依从性下降，被随机分配为密集干预或标准护理。这项研究将继续招募患者，并使用离散的结果（急性排斥，移植物丢失或死亡）来测试干预功效。 AIM 3-对250名移植前透析患者的前瞻性研究将监测其医疗依从性并在接受透析治疗时衡量行为特征。移植后，药物监测将继续进行，将遵循患者急性排斥，移植物丢失或死亡。确定与移植后行为和结果相关的特定移植前因素可能会导致新的移植前干预措施的新策略，从而可以改善透析和肾脏移植患者的预后。