Table 1 Description of studies

Annunziato 2015

Cohort study (retrospective chart review)

Included n = 25

Analyzed n = 22 (12, 10)

Two pediatric and adult kidney transplant service; USA

Age (mean, years) 21.68/21.03

Male 42%/40%

White 25%/0

African American 17/10

Hispanic 17%/70%

Asian 33%/0

Other race 8%/20%

Glomerular 64%/13%

Non-glomerular 36%/88%

Standard deviation of tacrolimus blood levels (mean) 1.98/2.42

NR

Auspices of the transition coordinator

Identifying and addressing gaps in self-management

Discussing transfer process including fears and concerns with patient and patient’s family members

Solving identified problems with patient, patient’s family, and team members

Facilitating last appointment in pediatrics

Completing “transition checklist” during last visit in pediatrics

Providing patient and patient’s family with information about their soon-to-be adult providers

Sharing impressions with members of adult team

Standard care

1 year; 1 year

Breu-Dejean 2016

RCT

Included n = 110 (55, 55)

Analyzed n = NR (12, 10)

Outpatient

clinic at Toulouse University Hospital; Toulouse,

France

Age (mean, years) 49.7/47.9

Number of immunosuppressants (mean) 2.8/2.7

Male 56.4%/49.1%

Single 27.3%/34.5%

Adherence score at first evaluation (mean) 29.9/32.0

Cyclosporine (dosing NR),

Sirolimus (dosing NR),

Tacrolimus (dosing NR),

Mycophenolate mofetil (dosing NR),

Enteric-coated mycophenolate sodium (dosing NR),

Prednisone (dosing NR),

Azathioprine,

Everolimus (dosing NR)

Psychoeducational intervention (every week)

Conducted by a multidisciplinary team

that included 1 physician, 1 psychologist, 2 nurses, 1 kinesiotherapist, 1 dietician, and 1 social worker

Main objectives: to provide information about disease and to translate this information into a form that enabled to gain increased competence during normal daily life

Standard care

8 weeks; 10 years

Chisholm 2001

RCT

Randomized n = 24 (12, 12)

Analyzed n = 24 (12, 12)

Medical College of Georgia (MCG) Hospital and Clinics in Augusta, Georgia, USA

Age (mean, years) 49.2 (10.2)

Male 75%

Caucasian 58.3%

African–American 37.5%

Hispanic 4.2%

Cyclosporine (dosing NR)

Tacrolimus (dosing NR)

Clinical pharmacy services

Medication histories and reviews (monthly)

Clinical pharmacist: counseling patients (verbally/written) concerning medications, recommendations to nephrologists, contact number given to patients

Assessment of patient understanding of medication therapy

Clinical pharmacist-patient interaction by telephone, if patient had no clinic visit within 1 month

Routine clinic services

1 year; 1 year

Chisholm 2013

RCT

Randomized n = 150

(76, 74)

Analyzed n = 150

(76, 74)

Southwest USA; Avella Specialty Pharmacy

Age (mean, years) 52.78/51.32 Annual income (mean, $) 39,673.96/28,290.44

Males 56.6%/55.4%

White 77.6%/82.4%

African–Americans 15.8%/14.9%

Hispanic 71.1%/68.9%

Married 40.8%/48.6%

Cyclosporine (dosing NR)

Tacrolimus (dosing NR)

Standard specialty pharmacy care

+ Individual behavioral adherence contracts (goal setting, motivation, social support, memory techniques, problem-solving, consequences of non-adherence) discussed with pharmacist every 3 months to discuss new goals etc.

Standard specialty pharmacy care

Mail or telephone reminders of monthly medication refills and an adherence ‘packet’ consisting of adherence-focused educational pamphlets and a pillbox

1 year; 1 year

De Geest 2006

(Pilot) RCT

Randomized n = 18 (6, 12)

Analyzed n = 13 (4, 9)

University Hospital Basel, Switzerland and Cantonal Hospital, Aarau, Switzerland

Non-adherent renal transplant recipients (identified in a previous study)

Age (mean, years) 45.6

Male 78.6%

Cyclosporine, Mycophenolae-Mofetil, Tacrolimus, Sirolimus (dosing: twice daily)

Azathioprin/Prednisone (dosing: once daily)

Enhanced usual care

1 home visit with assessment of reasons for adherence using EM printouts and tailored and individualized (behavioral, educational, and social support) interventions

+ 3 monthly telephone interviews (EM printouts for problem detection, feedback and proxy goal setting)

Enhanced usual care

Treating physicians were informed if their patients were identified as being non-adherent or if a moderate or severe depression or suicidal ideation was suggested

3 months; 9 months

Fennell 1994

Non-randomized trial (matched according to age and sex)

Included n = 29 (14, 15)

Analyzed n = NR

University of Florida; USA

Age (mean, years) 12.0

Male 59%

European-Amerikan 72%

African- or Latino-American 28%

NR

Family-based program

Educational booklet with information about transplantation;

Peer modeling videotape (with discussions about the need for compliance, benefits of a kidney transplant, and strategies for remembering to take medications)

Medication calendar to record medication compliance

Weekly rewards to the children from their parents

Usual care

NR; NR

Garcia 2015

RCT

Included n = 111 (55, 56)

Analyzed n = 111 (55, 56)

Universidade Estadual

Paulista; Botucatu; Brasil

Age (mean, years) 46.0/49.3

Male 56.4%/62.5%

Tacrolimus (dosing NR), Cyclosporine (dosing NR), Mycophenolate (dosing NR), Azathioprine (dosing NR), Prednisone (dosing NR)

Usual care

Education/counseling sessions aimed at improving delivered by a single healthcare professional with expertise in renal transplantation (10 weekly sessions, 30 min each); diverse topics which included information about the importance of taking immunosuppressive drugs even when the graft function is normal, using a non-judgmental

approach to discussing adherence and tools to integrate medication intake with the patient’s daily routine

Usual transplant

patient education by the medical team regarding the immunosuppressant

drugs in their first outpatient assessment after discharge

3 months; 1 year

Hardstaff 2003

RCT

Randomized n = 75

Analyzed at first outpatient visit: n = 48 (23, 25)

Analyzed at period after feedback: n = 40 (20, 20)

NR

Stable (>1 year post-transplant) renal transplant patients

Prednisolone/Azathioprine (dosing: once daily)

Feedback about self-medication behavior at first outpatient clinic visit

Usual care

Unique at first outpatient visit (2–6 months); 4–12 months (depending on first outpatient visit)

Henriksson 2016

RCT

Included n = 80 (40, 40)

Analyzed n = 80 (40, 40)

Karolinska University Hospital; Stockholm, Sweden

Age (mean) 44.3/45.0

Male 27/25

Tacrolimus (dosing: twice daily, or in “slow release” form once daily), cyclosporine (dosing: twice daily)

Electronic medication dispenser (EMD)

Loaded with a week’s worth of medication at a time

At the prescribed time for taking the medication visual and audible signals

After signals this (or after the medication was taken), the EMD sent an SMS message to the web-based software, thus providing information about patient compliance

Provider reviewed medication history

Standard care

2 years; 1 year

Joost 2014

Non-concurrent cohort study

Included n = 74

(39,35)

Analyzed n = 67 (35, 32)

Erlangen University Hospital, Germany

Age (mean, years) 51/54

Male 77%/62

Married 83%/82%

Tacrolimus/Cyclosporin/Mycophenolic acid

(dosing: twice daily)

Intensified Care Group

Standard care

+ pharmaceutical care: ≥ 3 counseling sessions including educational, behavioral and technical interventions (during week 1–2), further counseling sessions during follow-up visits throughout the 12 months (≥ 1 quarterly; ≤ 1 monthly), encouraged to contact the pharmacist via phone or email

Standard Care Group

Handout explaining post-transplant medication

+ 1–2 individual standardized training sessions (during 1–2 week)

+ scheduled follow-up visits

12 months; standard care 2 weeks

Russel 2011

(Pilot) RCT

Randomization n = 15 (8, 7)

Analyzed n = 13 (8, 5)

Tertiary care transplant centre; Midwestern USA

Medication non-adherent (taking < 85% of doses before inclusion)

Age (mean, years) 12.1/15.7

Male 50%/43%

Caucasian 100%/57%

Education level (some high school/high school) 63%/14%

Married 75%/43%

Pillbox use 88%/29%

≥ 1 immunosuppressive medication (medication not specified; dosing: twice daily)

Continuous self-improvement intervention

Identification of life routines, important people, and possible solutions to enhance medication taking

Individual monthly medication taking feedback

Focus on changing the systems in which the person lives using the plan-do-check-act process

Attention control intervention

Monthly educational brochures

Telephone calls to review the information and to ask participants whether they have any questions about the information

6 months; 6 months (plus prior 3 months adherence screening phase)

Tschida 2013

Cohort study (retrospective claims analysis)

Before propensity score matching n = 1830

Propensity-matched sample n = 1038 (519 pairs)

Mandatory program for the commercial employers of UnitedHealthcare, USA

UnitedHealthcare enrollees receiving pharmacy and medical benefits through UnitedHealthcare

≥ 1 prescriptions for an oral transplant study drug (dosing NR)

Specialty pharmacy program

Extensive patient education materials

Monthly proactive adherence program: refill reminder, adherence screening, and if non-adherent interventions with members and physicians

Transplant clinical management program: telephonic patient education, assessment of clinical status, pharmaceutical care intervention

Contact number 24 h available

No intervention

1 year; 1 year after index date (the first immunosuppressive drug prescription fill date)