NONCOMPLIANCE AND KIDNEY TRANSPLANTATION--ASSESSMENT AND INTERVENTION

Because the potential costs of noncompliance with medications are so high, the assessment, prediction, and improvement of compliance with treatment regimens among renal transplant recipients are crucial components of any comprehensive treatment plan. The specific aims of Project I.D.3 are to (1) assess the frequency of noncompliance in renal transplant recipients, and (2) to develop interventions to improve compliance. To address the first, a prospective chart study will determine the scope of the noncompliance problem, and identify key predictors of compliance behaviors. Charts of all consenting patients will be examined to identify reliable predictors and outcomes of compliance. Medical information (e.g., such predictors as transplant date, history of dialysis, and CsA toxicity, and such outcomes as number of post-transplant infections and rejection episodes) will be collected from medical charts. Data more closely related to compliance behaviors will also be collected from the charts assembled by transplant coordinators at the Transplant Center (e.g., proportion of prescribed phone calls completed, CsA levels noted in charts, patient- reported side effects, coordinators' ratings of patient compliance). This study will include one of the largest samples of renal transplant patients to date, and will provide for a comprehensive description of patients likely to comply and those relatively unlikely to comply. To address the second aim, data from the prospective chart study and Project I.D.2 will inform a controlled experiment designed to test the effectiveness of patient education efforts. All consenting patients will be randomly assigned to one of four treatment groups. Prior to discharge, the first group of patients will be exposed to the current education program, and the other three groups will be exposed to systematic variations of the current program. These variations are based on social psychological principles of persuasion. Further, half of the patients in each of these four groups will be assigned to receive a follow-up exposure to educational materials at their hospital visits three months post-transplant; the other half will receive no such follow-up. Intervention effectiveness will be assessed using compliance measures from the prospective chart study.