Therapeutic education of the renal transplant patient

Abstract

The success of kidney transplantation depends on the long-term immune-suppressive treatment; therapeutic education programs for transplant recipients are being implemented world-wide to help patients acquiring the needed skill to manage their treatment and lifestyle in the best possible way. (1) To assess knowledge and observance of transplant patients receiving immunosuppressive treatments, and (2) to develop information, monitoring tools and matrices of therapeutic education program (ETP) adapted to our patients. Our cross-sectional study was conducted in 100 kidney transplant patients followed in our department; age: 34 ± 10.8 years old; sex ratio: 1.76. Observance was assessed by the Girerd's questionnaire and knowledge of their medical status by a questionnaire consisting of 12 items. Eight % of patients did not respect their medical appointment dates. 25% had a good knowledge of their immunosuppressive treatment. The risk of not taking the immune-suppressant were well-known (more than 80% of correct answers), other notions concerning the mechanisms of action and the possible side effects were much less understood. The knowledge of the risks of treatment, lifestyle and diet was incomplete. The item evaluating what to do if the patient forgets to take a medication received the lowest percentage (5%) of correct answer. This level was significantly correlated with the educational level ( P = 0.02). Forty four percent of our patients were considered as good observers and 51% had minor observance problems. Irregularity in the time of intake appeared to be the main factor in patients’ poor compliance. No relation was evidenced between the level of knowledge of the patients and their level of observance. Our study revealed that our patients’ knowledge was fragmented and insufficient, likely limiting the observance and increasing the risk of kidney rejection. In order to improve this situation, we adapted the ETP methods to our patients’ pathology and established 4 educational tools: an information booklet on kidney transplantation, brochures on drug interactions, explanatory images and interactive maps. We organized information meetings to sensitize patients. This educational program has been appreciated by patients. A future evaluation of its impact on knowledge and observance is required. This ETP implemented in our service represents a considerable step forward in the management of kidney transplant patients. However, a well-structured program, led by a multidisciplinary team, must be implemented for ensuring the effectiveness and safety of treatment.