Predictors and Intervention for Noncompliance

不合规的预测因素和干预

• 批准号: 8537409
• 负责人: Thomas E Nevins
• 金额: $ 10.14万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8537409
• 关键词: Acute; Address; Adherence; Allografting; Animals; Anniversary; Azathioprine; Behavior; Cessation of life; Characteristics; Chronic; Chronic Kidney Failure; Chronology; Clinical; Coupled; Data; Development; Dialysis procedure; Dose; Electronics; Enrollment; Evaluation; Event; Frequencies; Functional disorder; Graft Rejection; Grant; Holidays; Immunosuppressive Agents; Incidence; Individual; Intervention; Intervention Trial; Kidney Transplantation; Malignant Neoplasms; Measurable; Measurement; Measures; Medical; Medical Technology; Monitor; Morbidity - disease rate; Mycophenolate; Natural History; Organ Transplantation; Outcome; Outpatients; Participant; Patients; Pattern; Personality; Pharmaceutical Preparations; Play; Prospective Studies; Randomized; Records; Recruitment Activity; Regimen; Research; Research Proposals; Role; Schedule; Sirolimus; Skin Cancer; Solid; System; Testing; Transplant Recipients; Transplantation; adverse outcome; allograft rejection; clinically relevant; cohort; compliance behavior; follow-up; high risk; improved; interest; intervention effect; man; medication compliance; non-compliance; prevent; prospective; psychologic; standard care; trend

Seeinstructions): Adherence with immunosuppressive medication is an essential component of successful solid organ transplantation. The recent advent of increasingly effective and potent drugs to prevent allograft rejection has generated new interest in medication adherence. While nonadherence certainly leads to adverse outcomes, that very observation highlights our lack of detailed information about the quality and quantity of medication adherence required for optimal results. This research proposal will prospectively apply electronic medication monitor technology (Medical Events Monitoring System - MEMS) to capture a quantitative chronology of immunosuppressive medication adherence and begin addressing at least three basic questions. Can an intervention focused on the least compliant patients improve or stabilize medication compliance? Aim 1- will complete enrollment and followup for a randomized study of an intensive intervention to improve medication-taking behavior. High-risk participants are prospectively identified by their early posttransplant noncompliance and stratified by their immunosuppressive drug regimen. Their behavior is tracked electronically during a two-year intensive intervention period with discrete clinical end-points including, acute or chronic rejection and graft loss. Can pretransplant adherence coupled with personality characteristics reliably predict post-transplant medication adherence and likely allograft outcomes? Aim 2- will complete a prospective study of 100 patients. Their medication adherence will be quantified before and after transplant. Those data together with specific personality attributes and demographic characteristics will then be combined to improve the prediction of each individual patient's post-transplant adherence behavior and outcome. What role does medication adherence play in later posttransplant morbidity? Aim 3- will critically examine late medical morbidity, specifically skin cancer, in a group of 137 renal transplant recipients who are 10 years posttransplant and now increasingly present with cancers. Their medication compliance was precisely quantitated during their first 4 years post-transplant and now appears positively associated with their development of cancer. Answers to each of these questions will permit us to substantially improve long-term renal transplant outcomes. RELEVANCE (Seeinstructions): There are fundamental questions about our ability to either predict or alter an individual patient's medication taking behavior. Now newer questions arise concerning the potential for adverse consequences in patients with excellent or over-adherence with immunosuppressive drugs. This research, by careful measurement of medication adherence and prospective followup of renal transplant patients will try to answer such questions.

see Instructions）： 遵守免疫抑制药物是成功固体器官的重要组成部分 移植。最近越来越有效和有效的药物出现以防止同种异体移植排斥 对药物依从性产生了新的兴趣。虽然不遵守肯定会导致不利 结果，这表明我们缺乏有关质量和数量的详细信息 最佳结果所需的药物依从性。该研究建议将前瞻性地应用电子 药物监测技术（医疗事件监测系统 - MEMS）以捕获定量 免疫抑制药物依从性的年代学，并开始解决至少三个基本 问题。 干预措施可以集中于最不合规的患者改善或稳定药物依从性吗？ AIM 1-将完成对密集干预的随机研究的入学和随访，以改善 服药行为。高风险参与者被他们的早期移植物前景确定 不合规，并通过其免疫抑制药物方案进行分层。他们的行为被跟踪 在两年密集的干预期内进行电子方式，并具有离散的临床终点，包括急性 或慢性排斥和移植损失。 可以在移植前的依从性以及人格特征可靠地预测移植后 药物依从性和可能的​​同种异体结果？ AIM 2-将完成对100的前瞻性研究 患者。他们的药物依从性将在移植前后进行量化。这些数据一起 然后将结合使用特定的个性属性和人口特征来改善 预测每个患者的移植后依从性行为和结果。 药物依从性在后来的移植后发病率中起什么作用？ AIM 3-将批判性检查 一组10年的肾脏移植受者，晚期医疗发病率，特别是皮肤癌 移植后，现在越来越多地与癌症一起出现。他们的药物合规性恰恰是 在移植后的头四年中进行了定量，现在似乎与他们的 癌症的发展。 这些问题的答案将使我们能够实质上改善长期的肾脏移植 结果。 相关性（参见Instructions）： 关于我们预测或改变个别患者药物的能力的基本问题 采取行为。现在，关于患者造成不利后果的可能性出现了更新的问题 免疫抑制药物具有出色或过度粘附。这项研究，仔细测量 肾移植患者的药物依从性和前瞻性随访将尝试回答此类问题。