Search

Background: We aimed to identify care processes and structures that were independently associated with higher medication adherence among young transplant recipients. Methods: We conducted a prospective, observational cohort study of 270 prevalent kidney, liver, and heart transplant recipients 14–25 years old. Patients were ≥3 months post‐transplant, ≥2 months post‐discharge, and followed in one of 14 pediatric or 14 adult transplant programs in Canada. Patients were enrolled between June 2015 and March 2018 and followed for 6 months. Adherence was assessed at baseline, 3, and 6 months using the BAASIS© self‐report tool. Patients were classified as adherent if no doses were missed in the prior 4 weeks. Transplant program directors and nurses completed questionnaires regarding care organization and processes. Results: Of the 270 participants, 99 were followed in pediatric programs and 171 in adult programs. Median age was 20.3 years, and median time since transplant was 5 years. At baseline, 71.5% were adherent. Multivariable mixed effects logistic regression models with program as a random effect identified two program‐level factors as independently associated with better adherence: minimum number of prescribed blood draws per year for those >3 years post‐transplant (per 1 additional) (OR 1.12 [95% CI 1.00, 1.26]; p =.047), and average time nurses spend with patients in clinic (per 5 additional minutes) (OR 1.15 [1.03, 1.29]; p =.017). Conclusion: Program‐level factors including protocols with a greater frequency of routine blood testing and more nurse time with patients were associated with better medication adherence. This suggests that interventions at the program level may support better adherence. [ABSTRACT FROM AUTHOR]

Introduction: Currently there is a lack of published data examining the clinical impact of pharmacy learners on patient care outcomes in acute care. A collaborative of hospital pharmacists in Canada established consensus on eight clinical pharmacy key performance indicators (cpKPIs) representing essential patient processes of care. Of the eight cpKPIs, admission medication reconciliation has been established as a cornerstone patient care process. The implementation of cpKPI measurement creates an opportunity to quantify pharmacy learner contribution to patient care. Aim: To determine if the presence of pharmacy learners partnering with pharmacists is associated with an increased number of patients receiving admission medication reconciliation (AMR). Methods: In this prospective observational study, pharmacists and learners (on 5‐week rotations) tracked patients receiving AMR in the electronic health record from 25 January to 17 July 2016. The number of patients receiving AMR were compared during timeframes when a learner was present (intervention) to when a learner was not present (control). Results: In the main analysis of 30 learner‐pharmacist pairs with 4684 patients, 1136 patients received AMR in the intervention group versus 887 patients in the control group (adjusted for 5 weeks). The number of patients receiving AMR in the presence of a pharmacy learner partnered with a pharmacist (median = 43, IQR = 23–59) was significantly increased compared to the presence of a pharmacist alone (median = 36, IQR = 17–53, p < 0.001). Learners partnered with pharmacists to perform AMR for 41% of the patients. Conclusion: Overall, pharmacy learners partnering with pharmacists increased the number of patients receiving AMR. [ABSTRACT FROM AUTHOR]

Introduction: Adverse symptoms experienced by solid organ transplant recipients remain largely unexplored despite their purported frequency., Objective: To characterize patient perspectives on adverse symptoms, identifying the most problematic symptoms and the perceived cause and treatability, and to evaluate their impact on quality of life (QoL) and medication adherence., Methods: An electronic survey was distributed to members of the Canadian Transplant Association, to characterize perceptions on symptom experience (Modified Transplant Symptom Occurrence and Distress Scale), and QoL (Short Form-12), medication adherence (Basel Assessment of Adherence to Immunosuppressive Medications Scale), demographics, and clinical situation., Results: The questionnaire was distributed to 249 solid organ transplant recipients and achieved a 51% response rate (N = 127). Respondents reported a mean of 25 (standard deviation 10) adverse symptoms each. In women, the most prevalent and distressing symptoms were tiredness, lack of energy, sleep difficulties, difficulty concentrating or memory problems, diarrhea, joint pain, and depression. In men, they were tiredness, flatulence, lack of energy, sleep difficulties, and erectile problems. With the exception of flatulence, these symptoms were more often perceived to be caused by medical conditions rather than by immunosuppressants or other medications. Quality of life was similar to the general public, with mean physical and mental component scores of 47.4 (9.9) and 52.1 (8.2), respectively (relative to a US average of 50 [10]). However, QoL scores inversely correlated to the number of symptoms reported and were higher in patients who perceived all symptoms to be treatable., Conclusion: Adverse symptoms may impact patient well-being. Perceived cause and treatability should be further explored.

The introduction of generic immunosuppressant medications may present an opportunity for cost savings in solid organ transplantation if equivalent clinical outcomes to the branded counterparts can be achieved. An interprofessional working group of the Canadian Society of Transplantation was established to develop recommendations on the use of generic immunosuppression in solid organ transplant recipients (SOTR) based on a review of the available data. Under current Health Canada licensing requirements, a demonstration of bioequivalence with the branded formulation in healthy volunteers allows for bridging of clinical data. Cyclosporine, tacrolimus, and sirolimus are designated as "critical dose drugs" and are held to stricter criteria. However, whether this provides sufficient guarantee of therapeutic equivalence in SOTR remains controversial, and failure to maintain an appropriate balance of immunosuppression may have serious consequences, including rejection, graft loss, and death. Published evidence supporting therapeutic equivalence of generic formulations in SOTR is lacking. Moreover, in the setting of multiple generic formulations the potential for uncontrolled product switching is a major concern, since generic preparations are not required to demonstrate bioequivalence with each other. Although close monitoring is recommended with any change in formulation, drug product switches are likely to occur without prescriber knowledge and may pose a significant patient safety risk. The advent of generic immunosuppression will require new practices including more frequent therapeutic drug and clinical monitoring, and increased patient education. The additional workload placed on transplant centers without additional funding will create challenges and could ultimately jeopardize patient outcomes. Until more robust clinical data are available and adequate regulatory safeguards are instituted, caution in the use of generic immunosuppressive drugs in solid organ transplantation is warranted.