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Assessment of immunosuppression adherence after solid organ transplantation: review and future directions

Moore, Cody (2017) Assessment of immunosuppression adherence after solid organ transplantation: review and future directions. Master Essay, University of Pittsburgh.

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Abstract

Medication non-adherence after solid organ transplantation is prevalent, with approximately 25% of transplant recipients not taking their medications as prescribed. Immunosuppression non-adherence leads to significant public health implications including transplanted organ failure, death, and increased patient and health system costs. Furthermore, more patients die on the organ transplant waiting list each year due to the scarcity of donated organs. Thus, it is critical for healthcare professionals to empower and educate transplant recipients to serve as the primary stakeholders in their medical care. A pressing challenge to optimal medication adherence after transplantation is due to a large burden of immunosuppression and anti-infection medicines. Furthermore, post-transplant medication regimens are complex and require patients to be precise with dosing times. Due to this complexity, delaying a dose by several hours can lead to detrimental clinical outcomes. Additionally, there have been numerous social and physical determinants linked to non-adherence with immunosuppression regimens. Research using validated scales or methods involving the measurement of immunosuppression adherence after transplantation is also scarce. Furthermore, effective interventional methods to improve medication adherence after transplantation have been largely absent. Successful interventions on immunosuppression adherence should not only educate patients, but also incorporate behavioral change to provide a lasting effect. Transplant teams may be interdisciplinary in nature where pharmacists often serve as the designated pharmacotherapy expert as identified by the United Network for Organ Sharing. In this environment, transplant pharmacists often see patients both before and after transplantation. Thus, transplant pharmacists are ideally positioned to assess and target patients at high risk for medication non-adherence in the pre-transplant phase. The pharmacist can then monitor high-risk patients after transplantation in order to optimize medication therapy outcomes. The objectives of this review are to assess the impact and prevalence of non-adherence after transplantation, define the determinants of non-adherence, and to propose a pharmacist-guided possible solution.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Moore, Codycam509@pitt.eduCAM509
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairFinegold, Daviddnf@pitt.edudnfUNSPECIFIED
Committee MemberEnsor, Christopherchris.ensor@pitt.educre16UNSPECIFIED
Date: April 2017
Date Type: Publication
Publisher: University of Pittsburgh
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Multidisciplinary MPH
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 28 Jul 2017 18:27
Last Modified: 17 Sep 2021 12:00
URI: http://d-scholarship.pitt.edu/id/eprint/31104

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