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Pediatric Kidney Transplantation: Identifying and Addressing Post-Transplant Barriers to Adherence Through an Integrated Healthcare Approach

Prutting, Carolyn (2020) Pediatric Kidney Transplantation: Identifying and Addressing Post-Transplant Barriers to Adherence Through an Integrated Healthcare Approach. Master's Thesis, University of Pittsburgh. (Unpublished)

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Medical non-adherence represents a significant challenge in health care treatment, and has demonstrated taxing effects on health outcomes and overall healthcare expenditures. UPMC Children’s Hospital of Pittsburgh serves a diverse population of pediatric kidney transplant patients, many of whom are deemed “high-risk” transplants, with high-risk encompassing various biopsychosocial components. A retrospective chart review demonstrated that many patients deemed low-psychosocial risk prior to transplant had higher rates of rejection in the first three years post-transplant, suggesting a need to implement post-transplant screenings assessing non-adherence and the continued involvement of a multidisciplinary medical team after transplant. Utilizing a socioecological lens, a multitude of factors were assessed by the CHP kidney transplant team as being relevant to patient adherence including social determinants of health, psychological functioning, and related adherence variables. The team developed the novel protocol highlighted in this paper in order to ensure access to the psychosocial team while identifying and addressing barriers to adherence in a standardized manner with collaboration across the interdisciplinary medical team. Kidney transplant patients followed at CHP and their parents/guardians completed a collection of measures as a component of this novel systematic protocol implemented in an integrated delivery system. Of the 148 eligible for annual post-transplant evaluations, the team completed annual evaluations on 82 patients and parents/guardians if applicable. Exclusion criteria was applied, and reasons for non-completion were coded appropriately and subsequently assessed. The data collected in year one and pilot program changes are used to assess overall reach, completion of data, themes of non-adherence, and the feasibility of a UPMC Quality Improvement project. These results can be used to inform future holistic assessments, protocols, medical practices, and potential for long-term implications while continuing these study aims prospectively. Public health significance pertains directly to the associated social determinants of health and subsequent implications on health systems and applicable policies.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Prutting, Carolyncrp65@pitt.educrp650000-0001-8362-5118
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorAlbert, Stevensmalbert@pitt.edusmalbert
Committee MemberHawk, Marymary.hawk@pitt.edumary.hawk
Committee MemberEngel, Rafaelrengel@pitt.edurengel
Date: 30 July 2020
Date Type: Publication
Defense Date: 22 April 2020
Approval Date: 30 July 2020
Submission Date: 31 March 2020
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 49
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: MPH - Master of Public Health
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: N/A
Date Deposited: 30 Jul 2020 17:21
Last Modified: 30 Jul 2020 17:21


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