ArticlePediatric transplantation2017
Assessing barriers to adherence in routine clinical care for pediatric kidney transplant patients.
Article in Pediatric transplantation, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- Poor-tasting pediatric medicines: Part 1. A scoping review of their impact on patient acceptability, medication adherence, and treatment outcomes.Frontiers in drug delivery · 2025Pooled it
- The Lived Experiences of Children Who Have Undergone Kidney Replacement Therapy and Their Families: Protocol for a Qualitative Systematic Review.JMIR research protocols · 2026Article
- It's About the Journey - Capturing Stories of the Fluctuating Experiences of Youth Kidney Transplant Patients.Proceedings of the ACM on human-computer interaction · 2024Article
- Understanding the impact of pediatric kidney transplantation on cognition: A review of the literature.Pediatric transplantation · 2023Review
- The Barriers Assessment Tool-A Patient-Centered Measure of Adherence Barriers in Pediatric Kidney Transplantation.Children (Basel, Switzerland) · 2023Article
- My Kidney Identity: Contextualizing pediatric patients and their families kidney transplant journeys.Pediatric transplantation · 2022Article
- A Cost-effectiveness Analysis of Adherence Promotion Strategies to Improve Rejection Rates in Adolescent Kidney Transplant Recipients.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2022Article
- Impact of Perceived Barriers on Patient Engagement and Attitudes towards Transition and Transfer.Children (Basel, Switzerland) · 2022Article
- Assessment of medication adherence in children and adults with congenital adrenal hyperplasia and the impact of knowledge and self-management.Clinical endocrinology · 2021Article
- Reflecting on patient-generated photographs of the pediatric renal transplant experience.Pediatric transplantation · 2021Article
- Providers' Perspectives on Adherence to Hormonal Therapy in Breast Cancer Survivors. Is there a Role for the Digital Health Feedback System?Health and technology · 2019Article
- Effect and features of information technology-based interventions on self-management in adolescent and young adult kidney transplant recipients: a systematic review.Adolescent health, medicine and therapeutics · 2019Article
- Age-associated decrease in de novo donor-specific antibodies in renal transplant recipients reflects changing humoral immunity.Immunity & ageing : I & A · 2019Article
- Does a multimethod approach improve identification of medication nonadherence in adolescents with chronic kidney disease?Pediatric nephrology (Berlin, Germany) · 2019Observational
- Predicting Health Care Utilization and Charges Using a Risk Score for Poor Adherence in Pediatric Kidney Transplant Recipients.Clinical practice in pediatric psychology · 2018Article
- Barriers to Adherence in Juvenile Idiopathic Arthritis: A Multicenter Collaborative Experience and Preliminary Results.The Journal of rheumatology · 2018Article
- Implementing a Process to Systematically Identify and Address Poor Medication Adherence in Pediatric Liver Transplant Recipients.Pediatric quality & safetyArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
Patient-identified barriers to immunosuppressive medications are associated with poor adherence and negative clinical outcomes in transplant patients. Assessment of adherence barriers is not part of routine post-transplant care, and studies regarding implementing such a process in a reliable way are lacking. Using the Model for Improvement and PDSA cycles, we implemented a system to identify adherence barriers, including patient-centered design of a barriers assessment tool, identification of eligible patients, clear roles for clinic staff, and creating a culture of non-judgmental discussion around adherence. We performed time-series analysis of our process measure. Secondary analyses examined the endorsement and concordance of adherence barriers between patient-caregiver dyads. After three methods of testing, the most reliable delivery system was an EHR-integrated tablet that alerted staff of patient eligibility for assessment. Barriers were endorsed by 35% of caregivers (n=85) and 43% of patients (n=60). The most frequently patient-endorsed barriers were forgetting, poor taste, and side effects. Caregivers endorsed forgetting and side effects. Concordance between patient-caregiver dyads was fair (k=0.299). Standardized adherence barriers assessment is feasible in the clinical care of pediatric kidney transplant patients. Features necessary for success included automation, redundant systems with designated staff to identify and mitigate failures, aligned reporting structures, and reliable measurement approaches. Future studies will examine whether barriers predict clinical outcomes (eg, organ rejection, graft loss).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.