Renal Transplantasyon Hastalarında İmmunsupresif Tedavinin Takibi ve Tedaviye Uyuncun İyileştirilmesi

Abstract

Renal transplant patients present a high rate of non-adherence to drug treatment. The objective of this study was to evaluate the impact of clinical pharmacist’s behavioral and educational strategy on treatment adherence of renal transplant patients. The new renal transplant patients (n=62) were divided in two groups: control group (n=31; routine transplant education) and educational group (n=31; routine transplant education plus clinical pharmacist education). After 3 months, in comparison to control group, a higher score was observed in the response to the first and second items of the Immunosuppressant Therapy Adherence Scale (ITAS) and total median ITAS score with the educational group (p=0.006, p<0.001 and p<0.001, respectively). The mean tacrolimus blood level was higher in the educational group (p<0.001). The patients who had a renal transplant for more than a year (n=175), were compared as pre and post education by clinical pharmacist. After 3 months, a higher score was observed in the response to the first, second, fourth items of the ITAS questionnaire and total median ITAS score after education (p<0.001, p<0.001, p=0.025 and p<0.001, respectively). The mean tacrolimus and cyclosporine blood levels were higher in post education compared to pre education (p<0.001). There was a statistically significant reduction in drug (tacroliimus, siklosporin, tacrolimus plus cyclosporine) costs as a result of regulation of new and old immunosuppressive drug doses in second visit according to the blood level (p<0.001). A statistically significant improvement was achieved in creatinine (p<0.001), blood urea nitrogen (p=0.034), uric acid (p=0.035) and hemoglobine (p=0.028) levels. The clinical pharmacist significantly contributed to the patient's awareness in new and more than one year tranplant patients; significant differences were achieved in 4 and 12 questions.