Fabienne Dobbels

Interventions used by health care professionals to enhance medication adherence in transplant patients: a survey of current clinical practice

Context Although medication nonadherence is associated with severe complications including graft rejection and loss, its prevalence remains high among organ transplant recipients. Still, little information exists on clinical use of interventions to improve medication adherence. Objective To identify transplant health care professionals methods of assessing medication adherence, classify the used interventions, and measure those interventions perceived effectiveness. Design, Setting and Participants A 46-item questionnaire on adherence assessment and interventions was distributed at the 2010 International Transplant Nurses Society symposium in Germany. Data were analyzed by using descriptive statistics. Results Of 141 distributed questionnaires, 94 (67%) were returned. Respondents with no direct patient contact (9%, n = 8) were excluded. The most frequently used assessment strategy was patient self-reporting (60%, n = 52). On average, participants reported using 47% of the educational/cognitive, 44% of the counseling/behavioral, and 42% of the psychological/affective interventions listed. Training patients to self-administer medications and providing printed adherence information were the most frequently used interventions (79% each, n = 68), followed by providing printed medication instructions (69%, n = 59). Most respondents (90%, n = 77) reported combining interventions. The intervention perceived as most effective was medication self-administration training. Conclusion Although available alternatives are demonstrably more effective for enhancing medication adherence, this sample relied more on educational interventions.

Development, content validity and inter-rater reliability testing of the Chronic Illness Management Implementation – Building Research Initiative Group: Chronic Illness Management and Adherence in Transplantation: An instrument to assess the level of chronic illness management implemented in solid organ transplant programmes

Introduction In this article we report the item generation, validity and inter-rater reliability testing of the Chronic Illness Management Implementation – Building Research Initiative Group: Chronic Illness Management and Adherence in Transplantation instrument. Methods The instrument was developed based on the World Health Organization’s Innovative Care for Chronic Conditions framework by the research team in consultation with a chronic illness management expert and a focus group of transplant nurses. Seven chronic illness management experts were used to assist in calculating the content validity index for each item and the total instrument. A pilot study was conducted in two transplant programmes to examine inter-rater reliability. Percent agreement by professionals working within the same centre was calculated by averaging the percent agreement on individual items. Results The instrument content validity index was 87%. The percentage agreement in both transplant programmes was 84.6% and 74.8%, indicating good inter-rater reliability. The final instrument consists of 55 items. Discussion The results are promising, suggesting its value as a tool to measure implementation of chronic illness management in transplant programmes.