Diploma of Community Services: Immunosuppressant Adherence Report

This report delves into the critical issue of non-adherence to immunosuppressants following renal transplantation. It emphasizes the importance of studying, measuring, and understanding adherence to prevent complications. The study aims to identify factors and barriers contributing to non-adherence, including social, economic, and psychological aspects, and assesses the potential role of transplant coordinators in improving patient outcomes. The report highlights the significance of interventions, such as educational, behavioral, and psychological strategies, and the use of assessment tools like the TAQ and IMAB questionnaires to understand patient knowledge, awareness, and behaviors. It underscores the need for a patient-centered approach, shared decision-making, and the integration of technology to improve patient adherence to immunosuppressant therapy and reduce the risk of graft rejection.

RUNNING HEAD: DIPLOMA OF COMMUNITY SERVICES
DIPLOMA OF COMMUNITY SERVICES
Name of Student
Name of University
Author note

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Title - Non-adherence to Immunosuppressant’s Following Renal
Transplantation: Can the Transplant Coordinator Make Difference?
Abstract
It is very important that the level of adherence to the drug therapy
(immunosuppressant therapy) is studied, measured ad understood by the health care specialist
in a post-transplant scenario so as to prevent any complications further down the future. The
adherence, good, bad, moderate or poor to immunosuppressant therapy in terms of various
kidney transplant cases – performed in a hospital. One of the major objectives of the study is
to understand the various factors and barriers to understanding of the non-adherence to
immunosuppressant therapy that is targeted at diminishing the immunological function of the
body that are build towards rejecting the graft (la rosa, rubulotta and beesley 2017). The
various types of drug therapy that have adverse reactions in the body can lead to graft
rejection which can have even a fatal impact on the life of the patient. Hence, the TAQ that
was done to identify non-adherence it’s the kind of short recall, BAAIS recall will be
monthly, the IMAB will be used to identify the specific barrier and for each barrier will the
proper intervention (Baron et al. 2017). The study finds out important correlation between the
post-transplant social, economic, socioeconomic factors that leads to immunosuppressant non
adherence and the interventions are recommended on a pertinent basis (Eswarappa et al.
2019).
Objectives
Organ transplantation is a very complex method of coping with organ damage or
pathophysiological failure of the organ due to age related factors, infection, metabolic or
genetic dysfunctions. Systematic issues in the body can also lead to various types of
pathologies that can affect the functionality of an organ. Under these circumstances, it

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becomes very important the organ is replaced so as to restore the normal or at least near
normal functionality of the system that the organ is a part of. It is to be considered that while
various types of interventions are important to maintain the complete health status and well-
being of the patient with organ failure and above all, in severe cases, the most apt way of
managing a severe organ failure situation is organ transplantation (Chisholm-Burns et al.
2016). The aim of the study is to understand non-adherence to immunosuppressant’s
following renal transplantation and to understand whether the transplant coordinator can
make the difference. The study focusses on understanding the various aspects of interventions
and sides of the outcomes in the patient, presented mentally, physically and socially
following a transplantation procedure and it is highly important that the immunological
intervention is controlled in a very profound manner so as to balance the level of suppression
and the level of adherence of the patient to the immunosuppression therapy (Dierickx and
Habermann, 2018). It is very important that the level of adherence to the drug therapy
(immunosuppressant therapy) is studied, measured ad understood by the health care specialist
in a post-transplant scenario so as to prevent any complications further down the future. The
adherence, good, bad, moderate or poor to immunosuppressant therapy in terms of various
kidney transplant cases – performed in a hospital (Kirchhof et al. 2018). One of the major
objectives of the study is to understand the various factors and barriers to understanding of
the non-adherence to immunosuppressant therapy that is targeted at diminishing the
immunological function of the body that are build towards rejecting the graft (Garaix et al.
2018). The purpose of the study is to analyze the underpinnings of the factors that help in the
immunosuppressant adherence process that is again important for the outcomes of the renal
transplant process. The shared responsibilities of the health care staffs in the renal transplant
intervention and the health, behavioral and mental outcomes of the patient in post-transplant
scenarios. The renal transplantation which is done in cases of acute kidney failure, although

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serves to be beneficial under many different circumstances (Shin and Chandraker, 2017). But
as a matter of fact, poses a lot of problems like graft rejection and other issues. That is the
reason why it is very important that the immunosuppression therapy is started in order to
prevent any immunological activation against the transplanted graft (Cossart et al. 2019). But
this has a lot of issues again such as non-adherence to drugs and other immunological
problems when the post-transplant subject shows a non- adherence to the immunosuppressant
therapy (Eisenberger et al. 2017). The purpose of the study is to understand the adherence or
the non-adherence process in relation to immunosuppression process following a renal
transplantation and the objective of the study is not only to differentiate between the various
level of assessments and measurement process required at the post transplantation clinic in
order to understand the entire drug adherence process as the non-adherence to the
immunosuppressant therapy that again lead to various types of physical and mental health
issues and finally leading to graft rejection as well (Opelz et al. 2016). Hence, another
important objective of the study is to identify the various factors that act as markers of non-
adherence to immunosuppressant therapy and how it is done and performed in the clinic,
forms the main pivotal aspect of the research study. The sociological, educational and
psychological aspects are the three main and major factors that are applied in form of both
assessments and interventions that make the clinical care must more focused in a patient
centered manner (Cukor et al. 2017). The various types of assessments that are used in the
post transplantation clinic – are important as well as very pertinent in understand the
behavioral, awareness, psychological and knowledge state of an individual who has already
had a renal transplantation and who is undergoing a immunosuppressant therapy, in the
current state. It is important the patient who has a renal transplantation has good adherence or
moderate level safe adherence with drug therapy and this is why, the educational and the
sociological as well as the psychological assessment are important that they are taken

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properly by the health care professionals working at the hospitals and clinics and it is very
critical that the assessment begin right after the transplantation which in this case, is renal
transplantation and the research study here focuses and aims to understand the various
implications of the patients who are on immunosuppressant therapy and whether they have a
good adherence to the provided or delivered immunosuppressant therapy or not. The study
attempts to understand the correlation between knowledge and actual adherence process to
immunosuppressant therapy following a renal transplantation procedure. The various types of
vital aspects of the objectives that being followed and aimed by the study’s researchers are
focused at understanding the efficiency of the assessments such as in the form of various
questionnaires and various responses to the same questionnaires that determines the sense of
well-being attached and associated with correct and appropriate immunosuppression drug
adherence following a renal transplant.
The objectives of the study can be summarized as follows: -
1. To understand Non-adherence to Immunosuppressant’s Following Renal
Transplantation
2. To understand whether the Transplant Coordinator Make Difference?
3. To understand the effect of educational intervention to better the patient centered care
pertaining to non-adherence to immunosuppressant therapy following a renal
transplantation.
4. To understand the effect of behavioral intervention to better the patient centered care
pertaining to non-adherence to immunosuppressant therapy following a renal
transplantation
5. To understand the effect of psychological intervention to better the patient centered
care pertaining to non-adherence to immunosuppressant therapy following a renal
transplantation.

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State-of-art
The interventions which are planned are educational, then behavioral and also the
mental health interventions are given to the subjects on post renal transplant
immunosuppressant therapy to understand and address the issues pertaining with non-
adherence with immunosuppressant therapy. The various types of the interventions that are
used in the most recent times are motivational interviewing, motivational counselling and the
various other types of therapies and intervention techniques targeted at improving the
knowledge and awareness of the subject or the family of the subject, regarding the sequence
and the functionality of immunosuppressant drugs. With the right knowledge and awareness
of the patient along with the shared decision making policies in the hospital that would
improve just not the adherence rates of the patients with drug therapy but also increase the
performance of the immunosuppressant drug therapy in the patients along with the various
types of other benefits including faster post-transplant recovery and decreased chances of
graft rejection (Bräsen et al. 2017). The various assessments such as the questionnaires can
be used to change the course of action of the post renal transplant subjects in pertinence with
the right method and procedure of drug intake, with water and after or before meal but at
different times of the day.

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The various technological parameters and the various types of questionnaires are very
vital that the same are adhered to in a very pertinent manner, by the clinic coordinator and the
health care staffs involved in the care process so that the financial, social and clinical
concerns of the patients are solved in a very imperative manner. Very importantly though, the
motivational interviewing techniques, in the modern decade and era has been reported to be
very effective and impactful in the making the post renal transplant patient understand the
benefits and vitality of each immunosuppressant drug so that the clinical process and the
immunosuppressant or anti-rejection drug adherence process run in a very efficient manner
and it is vital that the shared decision making is facilitated from the start of the transplant
process and through the course of the post-transplant immunosuppressant therapy, the shared
decision making in the drug adherence process to prevent any adverse effects is very
important indeed. In the modern times – the state-of-the-art targets the holistic treatment and
counselling of the patients with respect to right understanding of the drug adherence process
compliance (DeZern et al. 2019). The self-awareness of the patients with respect to the drug
adherence process is educated as well as a part of the interventions that are used to promote
drug compliance and drug adherence in the patients with post renal transplant conditions, in
relation to non-adherence to immunosuppressant’s following renal transplantation – can be
surely impacted by the transplant coordinator (Sharif and Cohney 2016). In the new age,
there are certain evidence based practice guidelines that are to be practiced by the transplant
coordinator in order to form a more meaningful patient centered care process in the post renal
transplant subjects (Nevins, Nickerson and Dew, 2017). The family can be counseled as well
and recreational activities can also be promoted in order to improve drug adherence in the
post-transplant subjects. Recreational activities can improve cognition and behavior of the
patient who have recall and memory issues and this is very important that the drugs are
undertaken in a normal way without any time and memory issues.

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The different types of interventions pertaining to socioeconomic counselling and the
motivational interviewing as well as the delivery of bundled care and other insurances that
supports the care process is helpful as well. It is very vital that the technologies and the
advanced biomedical technologies are blended with the skilled post-transplant care workforce
to support and aid the process of improving the psychosocial conditions of the patients is also
used as the important intervention method to improve drug adherence with
immunosuppressant therapy. It is critical to understand that the side effects of
immunosuppressant therapy is a huge adverse event and this can lead to deterioration of the
patient’s health as well as the fear of the patient regarding the adverse health condition is
increased and this is where the interventions pertaining to motivational encouragement of the
post renal transplant patient and to help with the physical assessment is critical as well. The
most important aspect of the state of the art in
Methodology
Rationale

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A qualitative data collection will be used in order to understand the individual
perspectives in a better manner and three questionnaires will be used to collect and determine
the data. The idea of this methodology is to understand the educational, social and
psychological perspective from an all-encompassing manner and in order to explore the
various types of gaps pertaining to individual cases of drug and non-drug adherence – would
be remarkable and significant while translating the results of the research to a higher
application setting (Kamar et al. 2016). The questionnaire only reflect and address the
knowledge, perception and level of awareness of the post- renal transplant patients who has
participated in the research but it also reflects on the sociological, personality, behavioral,
emotional, cognitive and physical aspects of the non-adherence issues. The counseling of the
patients in relation to the same will be then delivered. Data will be analyzed using SPSS.
Research philosophy
The various important aspect of the finding that the research study here focusses to
find and understand, is based on a positivist research philosophy. Positivist philosophy refers
to the understanding and collection plus analysis of data based on observation and the data is
objectified. So, a statistical analysis is undertaken on most cases. The main aim of this
research is to direct and understand plus explain and elaboration major underpinnings of the
non- adherence to immunosuppressant therapy based on post-transplant condition of the
patient. Although various factors such as educational, sociological, behavioral and
psychological factors are analyzed in relation to the research problem that is Non-adherence
to Immunosuppressant’s Following Renal Transplantation and how can a Transplant
Coordinator in the post-transplant clinic make a substantial difference to the health condition
of the renal transplant subject, contributing to better behavioral management in relation to
immunosuppressant therapy adherence. Hence, the researchers of this study uses a three
questionnaire system to understand and analyses the data pertaining to behavior, cognition,

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understanding, perception, obedience and awareness, knowledge of the subjects in addition to
the correct lifestyle changes of the patient in order to promote drug adherence in a post-renal
transplant scenario, so that there are least or no chances or risks of graft rejection.
Research approach
An exploratory research is undertaken to understand and realize the role of transplant
coordinator in effective management of the non-adherence cases to immunosuppressant
therapy in a post renal transplant case. The idea of this research is to explore more
possibilities and areas where the awareness and self-care of the individuals in context with
drug adherence has to be managed in a pertinent manner and the exploratory research
provides us with the right opportunity to understand and recognize the new perspectives
about the behavioral, psychological and physical aspects of research in a more apt manner.

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1.1 Population
Randomized controlled trials will be used in order to sample the post-transplant patients in
the transplant clinic.
1.2 Sample Design
300 patients with be selected with random selection, within a period or rather a time span of 3
months.
5 minutes extra time will be required by the transplant coordinator per patients to finish the
Adherence Toolkit questionnaires in a pertinent manner.
1.3 Data Collection
Three questionnaires will be used which are Transplant Adherence Questionnaire, BAASIS –
The Basel Assessment of Adherence to Immunosuppressive medication Scale and IMAB-
Identifying Medication Adherence Barriers.
Three Adherence Toolkit questionnaires with the details are listed -
TAQ –Transplant Adherence Questionnaire:
 Adapted the transplant population from the brief antiretroviral
adherence.
 Completed either as an interview or for the recipient to complete alone.
 Consist of 6 questions recall time of 4 days.
IMAB-Identifying Medication Adherence Barriers:
 Completed either as an interview or for the recipient to complete alone.

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 List 28 statement referring to common barriers to medication taking,
with a category response option for each statement.
 Allows identification and prioritization of barriers for each recipient.
 Implement the appropriate intervention for a particular barrier.
BAASIS –The Basel Assessment of Adherence to Immunosuppressive medication Scale:
 Preferably used as an interview tool, but can also be completed by
the recipient.
 Take 5 minutes to complete and consist of 6 questions recall time
of one month.
Transplant Adherence Questionnaire explores the various aspects of medication
adherence by the post renal transplant subject and how behaviorally, he was inclined himself
or herself with the adherence to immunosuppressant process. It is very critical that the post-
transplant patient understands the various aspects of the important behavioral and cognitive
parameters that are associated immunosuppressant therapy drug adherence. The various types
of important parameters are whether the patient is following the right instructions given by
the clinicians on whether to take the medicine with or without food or just with water and all
these forms the very important perspective of the immunosuppressant therapy drug adherence
process under post- renal transplant conditions (Dharnidharka et al. 2016). Not only on a
qualitative aspect but also on a very quantitative aspect, the questionnaire calculates or rather
collects the data around the patient conditions with respect to the number of times he or she
has missed his doses and this is a vital factor in understanding the cognition and behavioral
implication of the post renal transplant patient. Lastly another very aspect is that the
Transplant adherence questionnaire also provides anti-rejection medication adherence
understanding in a detailed manner as well.