RESUMO
The objective of this randomized controlled trial was to assess the effects of a 1-year behavioral contract intervention on immunosuppressant therapy (IST) adherence and healthcare utilizations and costs among adult renal transplant recipients (RTRs). The sample included adult RTRs who were at least 1 year posttransplant, taking tacrolimus or cyclosporine and served by a specialty pharmacy. Pharmacy refill records were used to measure adherence and monthly questionnaires were used to measure healthcare utilizations. Direct medical costs were estimated using the 2009 Medicare Expenditure Panel Survey. Adherence was analyzed using the GLM procedure and the MIXED procedure of SAS. Rate ratios and 95% confidence intervals were estimated to quantify the rate of utilizing healthcare services relative to treatment assignment. One hundred fifty RTRs were enrolled in the study. Intervention group RTRs (n = 76) had higher adherence than control group RTRs (n = 74) over the study period (p < 0.01). And 76.1% of the intervention group compared with 42.7% of the control group was not hospitalized during the 1-year study period (RR = 1.785; 95% CI: 1.314, 2.425), resulting in cost savings. Thus, evidence supports using behavioral contracts as an effective adherence intervention that may improve healthcare outcomes and lower costs.
Assuntos
Terapia Comportamental , Ciclosporina/uso terapêutico , Imunossupressores/administração & dosagem , Transplante de Rim , Cooperação do Paciente/estatística & dados numéricos , Tacrolimo/uso terapêutico , Adulto , Idoso , Feminino , Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-IdadeRESUMO
The study objective was to determine the association between immunosuppressant therapy (IST) adherence and graft failure among pediatric renal transplant recipients (RTRs) using data reported in the United States Renal Data System (USRDS), which contains Medicare prescription claims. RTRs (Assuntos
Ciclosporina/uso terapêutico
, Rejeição de Enxerto/tratamento farmacológico
, Rejeição de Enxerto/epidemiologia
, Imunossupressores/uso terapêutico
, Transplante de Rim/estatística & dados numéricos
, Adesão à Medicação/estatística & dados numéricos
, Adolescente
, Criança
, Prescrições de Medicamentos/estatística & dados numéricos
, Feminino
, Sobrevivência de Enxerto
, Humanos
, Estimativa de Kaplan-Meier
, Masculino
, Medicare/estatística & dados numéricos
, Modelos de Riscos Proporcionais
, Tacrolimo/uso terapêutico
, Estados Unidos/epidemiologia