Results of a Behavioral Contract Intervention To Improve Adherence and Healthcare Outcomes among Renal Transplant Recipients

M. Chisholm-Burns, C. Spivey, J. Graff Zivin, J. Lee, E. Sredzinski

University of Tennessee College of Pharmacy, Memphis, TN
University of California, San Diego School of International Relations and Pacific Studies, San Diego, CA
University of Arizona College of Pharmacy, Tucson, AZ
Avella Specialty Pharmacy, Phoenix, AZ

Meeting: 2013 American Transplant Congress

Abstract number: D1727

PURPOSE: To report the results of a 12-month randomized controlled trial of an intervention using behavioral contracts to improve immunosuppressant therpy (IST) adherence and associated outcomes among renal transplant recipients (RTRs).

METHODS: The sample included adult RTRs who were at least one year post-transplant and received IST from a specialty pharmacy chain based in the Southwest U.S. The intervention group received the behavioral contract at baseline and every 3 months for one year; the control group received usual care. Pharmacy refill records were used to measure IST adherence and monthly questionnaires were used to measure healthcare utilizations. Medical costs were estimated using the 2009 Medicare Expenditure Panel Survey. Chi square and independent samples t-tests were used to assess associations between group assignment (intervention or control), RTR characteristics, and adherence. Ordinary least squares regression was used to assess the effect of the intervention on healthcare utilizations.

RESULTS: 135 RTRs completed the study. The majority was male (54.8%), receiving Medicare (86.7%), prescribed tacrolimus (91.1%), and had a deceased donor transplant (62.2%). Mean age was 51.95 years ± 13.26 and mean months post-transplant was 35.98 ± 41.2. Intervention RTRs had better IST adherence than control RTRs over the study period (p<0.05).

Table 1. Comparing IST Adherence Rates in the Intervention and Control Groups
Time Period	Intervention (n=67)	Control (n=68)	P value
Baseline	0.83 ± 0.22	0.83 ± 0.20	0.893
3 months	0.85 ± 0.23	0.83 ± 0.23	0.668
6 months	0.91 ± 0.16	0.81 ± 0.28	0.007
9 months	0.90 ± 0.19	0.82 ± 0.24	0.037
12 months	0.89 ± 0.2	0.79 ± 0.26	0.020
Study Period Average	0.88 ± 0.15	0.81 ± 0.18	0.013

Follow-up analysis 12 months after the study period notes a trend wherein the intervention group maintained higher IST adherence than the control group. Intervention RTRs also experienced reductions in ED visits (p<0.01) and hospitalizations (p<0.10), with mean annual cost savings of approximately $10,505 per RTR.

CONCLUSION: The evidence supports that behavioral contracts are an effective adherence intervention in RTRs that positively impacts healthcare outcomes and costs.

To cite this abstract in AMA style:

Chisholm-Burns M, Spivey C, Zivin JGraff, Lee J, Sredzinski E. Results of a Behavioral Contract Intervention To Improve Adherence and Healthcare Outcomes among Renal Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/results-of-a-behavioral-contract-intervention-to-improve-adherence-and-healthcare-outcomes-among-renal-transplant-recipients/. Accessed May 14, 2025.

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