Improving Medication Adherence and Outcomes in Adult Kidney Transplant Patients Using SystemCHANGETM: Results of the Medication Adherence Given Individual Change (MAGIC) Randomized Clinical Trial
1Surgery/Urology, University of Missouri School of Medicine, Columbia, MO, 2Transplant, University of Missouri Health Care, Columbia, MO, 3School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO, 4College of Nursing, University of Tennessee HSC, Memphis, TN, 5Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, 6Health Services and Outcomes Research, Children's Mercy Kansas City and Schools of Medicine and Pharmacy, University of Missouri-Kansas City, Kansas City, MO, 7School of Nursing, Indiana University, Indianapolis, IN
Meeting: 2019 American Transplant Congress
Abstract number: 523
Keywords: Graft function, Immunosuppression, Infection
Session Information
Session Name: Concurrent Session: Kidney Immunosuppression: Novel Regimens and Drug Minimization III
Session Type: Concurrent Session
Date: Tuesday, June 4, 2019
Session Time: 4:30pm-6:00pm
Presentation Time: 4:54pm-5:06pm
Location: Veterans Auditorium
*Purpose: Medication non-adherence is an obdurate problem associated with poor outcomes and staggering costs. Even with multi-faceted interventions, effect sizes reported in meta-analyses of medication adherence interventions have been very small. The purpose of the MAGIC study was to determine if the SystemCHANGETM intervention was more efficacious than attention control in increasing medication adherence and improving outcomes in adult kidney transplant recipients.
*Methods: The design was a single-blinded, 2-arm, RCT using repeated measures conducted from 2014-2018. Using convenience sampling, participants were recruited from five transplant centers in the Midwestern and southern US. The 6-month SystemCHANGETM intervention supported patient-designed, interventionist-guided, small experiments to assess personal daily life systems, how systems influence medication taking, and to determine improvement solutions. A 6-month maintenance phase was included.
*Results: An intention-to-treat analysis, censored for non-protocol related drop out, was conducted with data obtained from 84 study participants (91% retention). Average age 52.1 years, 60% male, 61% African-American. At 6-months, mean medication adherence for SystemCHANGETM (0.87, SD 0.13) and attention control (0.67, SD 0.20) differed significantly (0.20, 95% CI, 0.13-0.27, p <.001) with a 28% increase from baseline in SystemCHANGETM. At the completion of the 6-month maintenance, mean medication adherence for SystemCHANGETM (0.79, SD 0.24) and attention control (0.64, SD 0.20) differed by 0.15 (95% CI, 0.05-0.25, p = 0.003) with a 16% increase from baseline in SystemCHANGETM. Mean creatinine and BUN were lower in the SystemCHANGETM group at 12 months. Infections were higher in the SystemCHANGETM group at 6 and 12 months.
*Conclusions: This is the first fully powered RCT testing SystemCHANGETM to improve and maintain medication adherence in kidney transplant recipients. The intervention demonstrated statistically significant and clinical meaningful improvements in immunosuppressive medication adherence.
To cite this abstract in AMA style:
Wakefield MR, Ashbaugh CM, Remy L, Aholt D, Miller C, Ye S, Hathaway DK, Clark D, Staggs VS, Goggin K, Ellis RJ, Russell CL. Improving Medication Adherence and Outcomes in Adult Kidney Transplant Patients Using SystemCHANGETM: Results of the Medication Adherence Given Individual Change (MAGIC) Randomized Clinical Trial [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/improving-medication-adherence-and-outcomes-in-adult-kidney-transplant-patients-using-systemchangetm-results-of-the-medication-adherence-given-individual-change-magic-randomized-clinical-trial/. Accessed May 11, 2025.« Back to 2019 American Transplant Congress