Teenagers, by their very nature, do not like adhering to a strict schedule. They are notorious for pushing boundaries and taking risks.

So it should come as no surprise that many teenagers tend to be less adherent to medical treatments. Missing a pill or two, the consequences can be dire.

A study led by Bethany Foster, M.D. a pediatric nephrologist at McGill University Health Centre (MUHC) was recently published in the American Journal of Kidney Diseases showing their method of keeping teen patients compliant with their immunosuppressive therapy following kidney transplantation. For these patients, the consequences of poor compliance can be very costly.

“Missing your anti-rejection medicine, even only a few times, can lead to graft failure,” stated Dr. Foster, adding, “Given the shortage of organs available for transplant, every failure is not only a loss for the patient but also a loss for the transplant community.”

The study, known as TAKE-IT (Teen Adherence in Kidney transplant Effectiveness of Intervention Trial) compared results in teenagers and young adults (11 – 24 years old) who underwent a kidney transplant who were given an electronic reminders of when to take their medication plus meetings with a personal coach every 3 months to go over their adherence data. “Action-Focused Problem Solving” was used to address adherence barriers that were important to the patient. A total of 81 patients were assigned to this treatment to monitor their adherence to immunosuppressive therapy and their adherence was compare 88 patients who did not get electronic reminders or have coaching sessions. Adherence rates were monitored using the SimpleMed electronic pillbox.

After 1 year of following the patients, the researchers noted that patients in the intervention group were significantly more likely to take their prescribed medications (OR, 1.66; 95% CI, 1.15-2.39) and to take them at the correct time (OR, 1.74; 95% CI, 1.21-2.50) than those in the control group.

Interestingly, the pillbox may have been a bigger issue than the quarterly coaching sessions.  “Some people loved it and didn’t want to give the pillbox back, but others hated it and stopped using it for reasons such as the pillbox being unwieldy. Based on this feedback, the device is being re-designed,” noted Dr. Foster, adding, “Most teens, however, liked meeting with the coach.”

Lorraine Bell, M.D., director of the MUHC Pediatric Renal Transplant Program and the director of the Pediatric Transition to Adult Care Project at the Montreal Children’s Hospital of the MUHC added, “The coaching has a big impact as it does in sports and other activities – the encouragement and personal connection is important, because it’s not easy to be a teen or young adult with a chronic health condition.”

A 5-year follow-up study, called TAKE-IT TOO, is currently underway.

Reference

Foster BJ, Pai ALH, Zelikovsky N, et al. The study A Randomized Trial of a Multicomponent Intervention to Promote Medication Adherence: The Teen Adherence in Kidney Transplant Effectiveness of Intervention Trial (TAKE-IT). Amer J Kid Dis. 2018. In Press.  DOI: 10.1053/ j.ajkd.2017.12.012