{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T05:22:59Z","timestamp":1768281779109,"version":"3.49.0"},"reference-count":34,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2017,8,1]],"date-time":"2017-08-01T00:00:00Z","timestamp":1501545600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Patient\u2010identified 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\u2010transplant 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\u2010centered design of a barriers assessment tool, identification of eligible patients, clear roles for clinic staff, and creating a culture of non\u2010judgmental discussion around adherence. We performed time\u2010series analysis of our process measure. Secondary analyses examined the endorsement and concordance of adherence barriers between patient\u2010caregiver dyads. After three methods of testing, the most reliable delivery system was an EHR\u2010integrated 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\u2010endorsed barriers were forgetting, poor taste, and side effects. Caregivers endorsed forgetting and side effects. Concordance between patient\u2010caregiver 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).<\/jats:p>","DOI":"10.1111\/petr.13027","type":"journal-article","created":{"date-parts":[[2017,8,1]],"date-time":"2017-08-01T09:30:01Z","timestamp":1501579801000},"source":"Crossref","is-referenced-by-count":39,"title":["Assessing barriers to adherence in routine clinical care for pediatric kidney transplant patients"],"prefix":"10.1111","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0409-3799","authenticated-orcid":false,"suffix":"Jr","given":"Charles D.","family":"Varnell","sequence":"first","affiliation":[{"name":"Division of Nephrology &amp; Hypertension Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin L.","family":"Rich","sequence":"additional","affiliation":[{"name":"Division of Behavioral and Clinical Psychology Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"},{"name":"University of Cincinnati College of Medicine  Cincinnati OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Nichols","sequence":"additional","affiliation":[{"name":"Division of Nephrology &amp; Hypertension Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Devesh","family":"Dahale","sequence":"additional","affiliation":[{"name":"James M. Anderson Center for Health Systems Excellence Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens W.","family":"Goebel","sequence":"additional","affiliation":[{"name":"Division of Nephrology Children's Hospital Colorado  Aurora CO USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahna L. H.","family":"Pai","sequence":"additional","affiliation":[{"name":"Division of Behavioral and Clinical Psychology Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"},{"name":"University of Cincinnati College of Medicine  Cincinnati OH USA"},{"name":"Center for Treatment Adherence and Self\u2010Management Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David K.","family":"Hooper","sequence":"additional","affiliation":[{"name":"Division of Nephrology &amp; Hypertension Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"},{"name":"University of Cincinnati College of Medicine  Cincinnati OH USA"},{"name":"James M. Anderson Center for Health Systems Excellence Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avani C.","family":"Modi","sequence":"additional","affiliation":[{"name":"Division of Behavioral and Clinical Psychology Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"},{"name":"University of Cincinnati College of Medicine  Cincinnati OH USA"},{"name":"Center for Treatment Adherence and Self\u2010Management Cincinnati Children's Hospital Medical Center  Cincinnati OH USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,8]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"2016 USRDS annual data report: Epidemiology of kidney disease in the United States","author":"United States Renal Data System","year":"2016"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e31823411d7"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-009-1174-1"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2010.01299.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2009.02793.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-1635"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-5151(03)00091-4"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/109019818401100101"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsm030"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsq025"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsj096"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsr092"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsp126"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/02739610902813245"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2010.03.009"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2008.00940.x"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2015-004411"},{"key":"e_1_2_8_19_1","volume-title":"The Improvement Guide: A Practical Approach to Enhancing Organizational Performance","author":"Langley GJ","year":"2009"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/qhc.12.6.458"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1198\/000313006X152243"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.12648"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-2374"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.3310\/hsdr03270"},{"key":"e_1_2_8_25_1","volume-title":"The Health Care Data Guide: Learning from Data for Improvement","author":"Provost LP","year":"2011"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs.2009.037895"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-015-0362-x"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40271-014-0090-z"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.12480"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsu026"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-1740"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1331\/JAPhA.2013.12202"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.12400"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-3639"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fpetr.13027","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.13027","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T16:13:26Z","timestamp":1696004006000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.13027"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8]]},"references-count":34,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2017,11]]}},"alternative-id":["10.1111\/petr.13027"],"URL":"https:\/\/doi.org\/10.1111\/petr.13027","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"value":"1397-3142","type":"print"},{"value":"1399-3046","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,8]]},"article-number":"e13027"}}