The psychosocial impact of presenting adolescent transplant recipients with the possibility of a simplified regimen : implications for patient education during transition to self-managed care

Abstract

Introduction: As they transition from parentally controlled care to self-managed care, and from paediatric care to adult care, chronically ill adolescents are facing many challenges, one of them being to find their own ways of fitting their medication intake schedule into their daily liferoutines. The complexity and frequency of medication regimens is a well-documented risk factor of non-adherence in patients with a chronic disease. We hypothesized that a possible benefit of the conversion from a twice-daily formulation of tacrolimus (Prograf®) to once daily prolonged release tacrolimus (Advagraf®) in adolescent transplant patients might be a decrease of non-intentional non-adherence due to forgetfulness. The aim of our study was to assess the subjective experience of such change, including the impact on adherence to treatment. Methods: As a prerequisite to our study, the medical safety of such switch was assessed in 32 patients. At 8-week post-switch, a sub-sample of 11 patients underwent a semi-directed interview by an independent researcher, to assess the subjective impact of the switch. Results: The results of our study illustrate that the switch improved the young patients' self-efficacy and self-determination regarding self-managed care. The relevance of our hypothesis that a simplified regimen might be associated with increased adherence in this population is confirmed. Conclusions: We discuss strategies to support self-management and enhance adherence during the healthcare transition process of adolescents toward adult-oriented care. © 2012 EDP Sciences, SETE.