MAGIC Study

Aims, Design and Methods using SystemCHANGE™ to Improve Immunosuppressive Medication Adherence in Adult Kidney Transplant Recipients

Cynthia L. Russell, Shirley Moore, Donna Hathaway, An Lin Cheng, Guoqing Chen, Kathy Goggin

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Among adult kidney transplant recipients, non-adherence to immunosuppressive medications is the leading predictor of poor outcomes, including rejection, kidney loss, and death. An alarming one-third of kidney transplant patients experience medication non-adherence even though the problem is preventable. Existing adherence interventions have proven marginally effective for those with acute and chronic illnesses and ineffective for adult kidney transplant recipients. Our purpose is to describe the design and methods of the MAGIC (Medication Adherence Given Individual SystemCHANGE™) trial Methods/Design: We report the design of a randomized controlled trial with an attention-control group to test an innovative 6-month SystemCHANGE™ intervention designed to enhance immunosuppressive medication adherence in adult non-adherent kidney transplant recipients from two transplant centers. Grounded in the Socio-Ecological Model, SystemCHANGE™ seeks to systematically improve medication adherence behaviors by identifying and shaping routines, involving supportive others in routines, and using medication taking feedback through small patient-led experiments to change and maintain behavior. After a 3-month screening phase of 190 eligible adult kidney transplant recipients, those who are <85 % adherent as measured by electronic monitoring, will be randomized into a 6-month SystemCHANGE™ intervention or attention-control phase, followed by a 6-month maintenance phase without intervention or attention. Differences in adherence between the two groups will be assessed at baseline, 6 months (intervention phase) and 12 months (maintenance phase). Adherence mediators (social support, systems-thinking) and moderators (ethnicity, perceived health) are examined. Patient outcomes (creatinine/blood urea nitrogen, infection, acute/chronic rejection, graft loss, death) and cost effectiveness are to be examined. Discussion: Based on the large effect size of 1.4 found in our pilot study, intervention shows great promise for increasing adherence. Grounded in the socio-ecological model, SystemCHANGE™ seeks to systematically improve medication adherence behaviors by identifying and shaping routines, involving supportive others in routines, and using medication taking feedback through small patient-lead experiments to change and maintain behavior. Medication adherence will be measured by electronic monitoring. Medication adherence persistence will be examined by evaluating differences between the two groups at the end of the 6-and 12- month phases. Mediators and moderators of medication adherence will be examined. Patient outcomes will be compared and a cost-effectiveness analysis will be conducted.

Original languageEnglish (US)
Article number84
JournalBMC Nephrology
Volume17
Issue number1
DOIs
StatePublished - Jul 16 2016

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Medication Adherence
Immunosuppressive Agents
Kidney
Cost-Benefit Analysis
Maintenance
Transplants
Transplant Recipients
Blood Urea Nitrogen
Graft Rejection
Systems Analysis
Social Support
Creatinine
Chronic Disease
Randomized Controlled Trials
Control Groups
Health

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

MAGIC Study : Aims, Design and Methods using SystemCHANGE™ to Improve Immunosuppressive Medication Adherence in Adult Kidney Transplant Recipients. / Russell, Cynthia L.; Moore, Shirley; Hathaway, Donna; Cheng, An Lin; Chen, Guoqing; Goggin, Kathy.

In: BMC Nephrology, Vol. 17, No. 1, 84, 16.07.2016.

Research output: Contribution to journalArticle

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