Management strategies for implementing a multicenter cross-sectional study

lessons from the ADHERE Brazil study

Authors

Keywords:

Patient compliance, Multicenter study as topic, Kidney transplantation, Health information management, Data collection

Abstract

BACKGROUND: Epidemiological studies involving large samples usually face financial and operational challenges. OBJECTIVES: To describe the planning and execution of ADHERE Brazil, an epidemiological study on 1,105 kidney transplant patients, and report on how the study was structured, difficulties faced and solutions found. DESIGN AND SETTING: Cross-sectional multicenter study in 20 Brazilian kidney transplantation centers. METHODS: Actions developed in each phase of implementation were described, with emphasis on innovations used within the logistics of this study, aimed at estimating the prevalence of nonadherence to treatment. RESULTS: Coordination of activities was divided into four areas: general, regulatory, data collection and statistics. Weekly meetings were held for action planning. The general coordination team was in charge of project elaboration, choice of participating centers, definition of publication policy and monitoring other coordination teams. The regulatory team provided support to centers for submitting the project to ethics committees. The data collection team prepared a manual on the electronic collection system, scheduled web meetings and was available to respond to queries. It also monitored the data quality and reported any inadequacies found. Communication with the centers was through monthly reports via e-mail and distribution of exclusive material. The statistical team acted in all phases of the study, especially in creating the data analysis plan and data bank, generation of randomization lists and data extraction. CONCLUSIONS: Through these logistics, we collected high-quality data and built a local research infrastructure for further studies. We present supporting alternatives for conducting similar studies. CLINICAL TRIAL ANNOTATION: http://clinicaltrials.gov/ on October 10, 2013; NCT02066935.

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Author Biographies

Elisa Oliveira Marsicano-Souza, Universidade Federal de Juiz de Fora

RN, PhD. Professor, Renal Transplantation Unit, University Hospital, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora (MG), Brazil; and Researcher, Núcleo Interdisciplinar de Estudos, Pesquisas e Tratamento em Nefrologia (NIEPEN), Juiz de Fora (MG), Brazil.

Fernando Antônio Basile Colugnati, Universidade Federal de Juiz de Fora

PhD. Statistician and Professor, Renal Transplantation Unit, University Hospital, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora (MG), Brazil; and Researcher, Núcleo Interdisciplinar de Estudos, Pesquisas e Tratamento em Nefrologia (NIEPEN), Juiz de Fora (MG), Brazil.

Barbara Bruna Abreu de Castro, Universidade Federal de Juiz de Fora

PhD. Biologist, Renal Transplantation Unit, University Hospital, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora (MG), Brazil; and Researcher, Núcleo Interdisciplinar de Estudos, Pesquisas e Tratamento em Nefrologia (NIEPEN), Juiz de Fora (MG), Brazil.

Maria do Socorro Van Keullen, Universidade Federal de Juiz de Fora

RN, MSc. Nurse, Renal Transplantation Unit, University Hospital, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora (MG), Brazil; and Researcher, Núcleo Interdisciplinar de Estudos, Pesquisas e Tratamento em Nefrologia (NIEPEN), Juiz de Fora (MG), Brazil.

Sabina De Geest, Universidade Federal de Juiz de Fora

RN, PhD. Professor, Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland; and Professor, Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium.

Helady Sanders-Pinheiro, Universidade Federal de Juiz de Fora

MD, PhD. Professor, Renal Transplantation Unit, University Hospital, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora (MG), Brazil; and Researcher, Núcleo Interdisciplinar de Estudos, Pesquisas e Tratamento em Nefrologia (NIEPEN), Juiz de Fora (MG), Brazil.

References

World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003. Available from: https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf?sequence=1&isAllowed=y. Accessed in 2021 (Sep 22).

Nevins TE, Nickerson PW, Dew MA. Understanding Medication Nonadherence after Kidney Transplant. J Am Soc Nephrol JASN. 2017;28(8):2290-301. PMID: 28630231; https://doi.org/10.1681/ASN.2017020216.

Silva HT, Felipe CR, Abbud-Filho M, Garcia V, Medina-Pestana JO. The emerging role of Brazil in clinical trial conduct for transplantation. Am J Transplant. 2011;11(7):1368-75. PMID: 21668630; https://doi.org/10.1111/j.1600-6143.2011.03564.x.

Registro Brasileiro de Transplantes. Veículo Oficial da Associação Brasileira de Transplante de Órgãos. Dimensionamento dos Transplantes no Brasil e em cada estado. 2012-2019. Available from: http://www.abto.org.br/abtov03/Upload/file/RBT/2019/RBT-2019-leitura.pdf Accessed in 2021 (Aug 20).

Bittar AE, Keitel E, Garcia CD, et al. Patient noncompliance as a cause of late kidney graft failure. Transplant Proc. 1992;24(6):2720-1. PMID: 1465914.

Michelon TF, Piovesan F, Pozza R, et al. Noncompliance as a cause of renal graft loss. Transplant Proc. 2002;34(7):2768-70. PMID: 12431602; https://doi.org/10.1016/s0041-1345(02)03403-6.

Brahm MM, Manfro RC, Mello D, Cioato S, Gonçalves LF. Evaluation of adherence to immunosupressive drugs in kidney transplantation by control of medication dispensing. Transplant Proc. 2012;44(8):2391-3. PMID: 23026602; https://doi.org/10.1016/j.transproceed.2012.08.001.

Marsicano E de O, Fernandes N da S, Colugnati F, et al. Transcultural adaptation and initial validation of Brazilian-Portuguese version of the Basel assessment of adherence to immunosuppressive medications scale (BAASIS) in kidney transplants. BMC Nephrol. 2013;14:108. PMID: 23692889; https://doi.org/10.1186/1471-2369-14-108.

Garcia MF, Bravin AM, Garcia PD, et al. Behavioral measures to reduce non-adherence in renal transplant recipients: a prospective randomized controlled trial. Int Urol Nephrol. 2015;47(11):1899-905. PMID: 26377496; https://doi.org/10.1007/s11255-015-1104-z.

Marsicano EO, Fernandes NS, Colugnati FA, et al. Multilevel correlates of non-adherence in kidney transplant patients benefitting from full cost coverage for immunosuppressives: a cross-sectional study. PLoS One. 2015;10(11):e0138869. PMID: 26619070; https://doi.org/10.1371/journal.pone.0138869.

Silva AN, Moratelli L, Tavares PL, et al. Self-efficacy beliefs, locus of control, religiosity and non-adherence to immunosuppressive medications in kidney transplant patients. Nephrology (Carlton). 2016;21(11):938-43. PMID: 26636921; https://doi.org/10.1111/nep.12695.

Bessa AB, Felipe CR, Hannun P, et al. Prospective randomized trial investigating the influence of pharmaceutical care on the intra-individual variability of tacrolimus concentrations early after kidney transplant. Ther Drug Monit. 2016;38(4):447-55. PMID: 27414973; https://doi.org/10.1097/FTD.0000000000000299.

Berben L, Denhaerynck K, Dobbels F, et al. Building research initiative group: chronic illness management and adherence in transplantation (BRIGHT) study: study protocol. J Adv Nurs. 2015;71(3):642-54. PMID: 25257974; https://doi.org/10.1111/jan.12519.

Sanders-Pinheiro H, Colugnati FAB, Marsicano EO, et al. Prevalence and correlates of non-adherence to immunosuppressants and to health behaviours in patients after kidney transplantation in Brazil – the ADHERE BRAZIL multicentre study: a cross-sectional study protocol. BMC Nephrol. 2018;19(1):41. PMID: 29463231; https://doi.org/10.1186/s12882-018-0840-6.

Organização Pan-Americana da Saúde. Boas práticas clínicas: documento das Américas. In: IV Conferência Pan-Americana para Harmonização da Regulamentação Farmacêutica; 2005. Available from: http://antigo.anvisa.gov.br/documents/33836/2492465/Documento±das±Am%C3%A9ricas±-±Boas±Pr%C3%A1ticas±Cl%C3%ADnicas/4b42857a-49f4-4a63-80a1-70ebc439e234 Accessed in 2021 (Sep 21).

World Health Organization. The WHO Strategy on Research for Health. Geneva, Switzerland: World Health Organization. Available from: http://www.who.int/phi/WHO_Strategy_on_research_for_health.pdf Accessed in 2021 (Sep 21).

Cheng A, Kessler D, Mackinnon R, et al. Conducting multicenter research in healthcare simulation: Lessons learned from the INSPIRE network. Adv Simul (Lond). 2017;2:6. PMID: 29450007; https://doi.org/10.1186/s41077-017-0039-0.

Chung KC, Song JW; WRIST Study Group. A guide to organizing a multicenter clinical trial. Plast Reconstr Surg. 2010;126(2):515-23. PMID: 20375760; https://doi.org/10.1097/PRS.0b013e3181df64fa.

Payne JM, France KE, Henley N, et al. Researchers’ experience with project management in health and medical research: results from a post-project review. BMC Public Health. 2011;11:424. PMID: 21635721; https://doi.org/10.1186/1471-2458-11-424.

Sanders-Pinheiro H, Colugnati FAB, Denhaerynck K, et al. ADHERE BRAZIL Study Team. Multilevel Correlates of Immunosuppressive Nonadherence in Kidney Transplant Patients: The Multicenter ADHERE BRAZIL Study. Transplantation. 2021;105(1):255-66. PMID: 32150041; https://doi.org/10.1097/TP.0000000000003214.

Ministério da Saúde (BR). Conselho Nacional de Saúde. Resolução nº 466, de 12 de dezembro de 2012. Diretrizes e normas regulamentadoras de pesquisa envolvendo seres humanos. Diário Oficial da União da República Federativa do Brasil. 2013 jun 13;150(112 Seção 1):59-62. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/cns/2013/res0466_12_12_2012.html Accessed in 2021 (Sep 21).

Gómez L, Jaramillo A, Halpaap B, et al. Building research capacity through “Planning for Success”. PLoS Negl Trop Dis. 2019;13(8):e0007426. PMID: 31369556; https://doi.org/10.1371/journal.pntd.0007426.

Aitken LM, Pelter MM, Carlson B, et al. Effective strategies for implementing a multicenter international clinical trial. J Nurs Scholarsh. 2008;40(2):101-8.; PMID: 18507563; https://doi.org/10.1111/j.1547-5069.2008.00213.x.

Huggett KN, Gusic ME, Greenberg R, Ketterer JM. Twelve tips for conducting collaborative research in medical education. Med Teach. 2011;33(9):713-8. PMID: 21854148; https://doi.org/10.3109/0142159X.2010.547956.

Cole DC, Boyd A, Aslanyan G, Bates I. Indicators for tracking programmes to strengthen health research capacity in lower- and middle-income countries: a qualitative synthesis. Health Res Policy Syst. 2014;12:17. PMID: 24725961; https://doi.org/10.1186/1478-4505-12-17.

Bento SF, Hardy E, Hebling EM, Pádua KM, Osis MJD. The Brazilian Ethics Research Review System: An Evaluation from the Perspectives of Institutional Review Boards. AJOB Primary Research, 2011,2(3):28-37, https://doi.org/10.1080/21507716.2011.580493.

Lopes Júnior LC, Nascimento LC, Lima RA, Coelho EB. Difficulties and challenges in reviewing ethical aspects of research in Brazil. Rev Gaucha Enferm. 2016;37(2):e54476. PMID: 27253590; https://doi.org/10.1590/1983-1447.2016.02.54476.

Marsolo K. Approaches to facilitate institutional review board approval of multicenter research studies. Med Care. 2012;50 Suppl:S77-81. PMID: 22692264; https://doi.org/10.1097/MLR.0b013e31825a76eb.

Adams-Huet B, Ahn C. Bridging clinical investigators and statisticians: writing the statistical methodology for a research proposal. J Investig Med. 2009;57(8):818-24. PMID: 19875966; https://doi.org/10.2310/JIM.0b013e3181c2996c.

de Sandes-Freitas TV, Mazzali M, Manfro RC, et al. Exploring the causes of the high incidence of delayed graft function after kidney transplantation in Brazil: A multicenter study. Transpl Int. 2021;34(6):1093-1104. PMID: 33742470; https://doi.org/10.1111/tri.13865.

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Published

2022-05-05

How to Cite

1.
Marsicano-Souza EO, Colugnati FAB, Castro BBA de, Keullen M do SV, Geest SD, Sanders-Pinheiro H. Management strategies for implementing a multicenter cross-sectional study: lessons from the ADHERE Brazil study. Sao Paulo Med J [Internet]. 2022 May 5 [cited 2025 Mar. 9];140(3):439-46. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/929

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