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Transplantation and Adherence: Evaluating Tacrolimus Usage in Pediatric Patients With Cancer

Micah A. Skeens
Mary S. Dietrich
Nancy Ryan-Wenger
Mary Jo Gilmer
Shelagh A. Mulvaney
Terrah Foster Akard
CJON 2020, 24(5), E57-E64 DOI: 10.1188/20.CJON.E57-E64

Background: Researchers have estimated that about 50% of pediatric patients with chronic illness adhere to tacrolimus therapy, a medication responsible for preventing critical side effects in patients undergoing hematopoietic stem cell transplantation (HSCT).

Objectives: The purpose of this study was to describe patient adherence to tacrolimus by reviewing documentation from the electronic health record and therapeutic drug levels.

Methods: This retrospective descriptive study examined 357 clinic visits by 57 patients undergoing HSCT. Direct (tacrolimus levels) and indirect (subjective reporting) measures were evaluated.

Findings: The authors found that, in 51% of visits, adherence was not documented. The overall nontherapeutic drug level rate was 60%. Because of the small sample size, nonadherence did not statistically correlate with nontherapeutic levels. The findings highlight the need for adherence awareness, assessment, and documentation in clinical practice.

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