Monitorization of immunosuppressive therapy in renal transplant patients and improvement of their drug therapy adherence

Renal transplantation is the best treatment option for end stage kidney disease, lower cost, higher vocational rehabilitation, promoting better quality of life and longer survival compared with dialysis. However, renal transplant patients present a high rate of non-adherence to drug treatment. Few interventional studies have included approaches aimed at increasing adherence. The objective of this study was to evaluate the impact of clinical pharmacist's behavioral and educational strategy on treatment adherence of renal transplant patients. The new renal transplant patients (n=62) were divided in two groups: control group (n=31; routine transplant education) and educational group (n=31; routine transplant education plus clinical pharmacist education). After 3 months, in comparison to control group, a higher score was observed in the response to the firstand second items of the Immunosuppressant Therapy Adherence Scale (ITAS) and total median ITAS score with the educational group (p=0.006, p<0.001 and p<0.001, respectively). The mean tacrolimus blood level was higher in the educational group (p<0.001). After 3 months, tacrolimus blood level increased by 20% in educational group but decreased by 24% in control group. There were no difference in laboratory finding (i.e. renal function), number of hospital admissions, number of acute rejection, new-onset diabetes after renal transplantation and new-onset hypertension after transplantation. The patients who had a renal transplant for more than a year (n=175), were compared as pre and post education by clinical pharmacist. After 3 months, a higher score was observed in the response to the first, second, fourth items of the ITAS questionnaire and total median ITAS score after education (p<0.001, p<0.001, p=0.025 and p<0.001, respectively). The mean tacrolimus and cyclosporine blood levels were higher in post education compared to pre education (p<0.001). After education, tacrolimus and cyclosporine blood levels increased by 33.33% and 100% respectively. There was a statistically significant reduction in daily tacrolimus, cyclosporine and total immunosuppressive drug (tacrolimus plus cyclosporine) costs as a result of regulation of new and old immunosuppressive drug doses in second visit according to the blood level (p<0.001). In addition a statistically significant improvement was achieved in creatinine (p<0.001), blood urea nitrogen (p=0.034), uric acid (p=0.035) and hemoglobine (p=0.028) levels. When the responses to the 26 questionnaire were evaluated, it was determined that the clinical pharmacist significantly contributed to the patient's awareness in new and more than one year tranplant patients; significant differences were achieved in 4 and 12 questions respectively. In this thesis, as a result of clinical pharmacist behavioral and educational strategy addressing the patient's perceptions and knowledge about the immunosuppressive drugs, their adherence to immunosuppressive therapy was significantly improved which led to better treatment and economical outcomes.