Introduction: One of the major barriers to medication adherence is the number of medications pediatric heart transplant patients are required to take. The socioeconomic status and patient-related psychosocial factors also play a major role in medication adherence and post-transplant outcomes. Establishing a systematic way of medication organization and administration may improve adherence to the medication schedule. It is well known that medication non-adherence leads to transplant organ rejection. The medication level variability index (MLVI) is a tool used to help predict outcomes with greater variability correlating with a worse clinical status, including organ rejection, which can result in lengthy hospitalizations for treatment.
Methods: Adherence measures will be calculated by monitoring of medication level variability index (MLVI) scores. We will examine a patient’s date of blister-packaging initiation and determine if this intervention helps maintain therapeutic drug levels. MLVI is an economical extension of clinical practice and we will utilize retrospective data collection to obtain tacrolimus trough levels. Using the help of statisticians and statistical analyses, MLVI will be calculated as the Standard Deviation of a set of at least three tacrolimus trough blood levels for each patient.
Results: One limitation of this abstract is the small cohort of patients currently enrolled in medication blister-packaging as we are in the beginning stages of implementing this quality improvement initiative. Another limitation of this study is a patient selection bias relating to the assumption that the patients enrolled include those who do not require frequent titrations of medication dosages for immunosuppression. We did not include patients who are early post-transplant who require frequent medication dosage adjustments.
Conclusion: The overwhelming medication burden for patients early post-transplant or following a significant rejection episode can perpetuate the cycle of medication non-adherence. Therefore, it is imperative for transplant programs to adopt interventions that have shown promise related to increasing medication adherence. We believe that blister-packaging medications will be effective in reducing health care disparities that are related to social determinants of health factors. This will directly benefit patients from non-English speaking families, single parent household families, and families with low health literacy. We believe that as patients transition to medication blister-packaging, adherence to medications will increase. The simplicity of weekly blister-packaging have shown to be effective in helping patients better manage their medication regimen compared to taking pills directly from the bottle or filling up pill boxes. We hope that patients and family members who have language barriers or low health literacy can benefit from medication blister-packaging as well.