Disclosures: The authors report no relevant financial information.
A digital medication adherence program with virtual video recordings has been linked to adolescent heart transplant recipients taking more of their medications as prescribed 6 months after the procedure, pilot study data show.
“Medication non-adherence is a significant issue that can lead to transplant failure and patient mortality,” Dipankar Gupta, MBBS, DCH, MD, told Healio, assistant professor of pediatric cardiology at the Congenital Heart Center at UF Health Shands Children’s Hospital, University of Florida. “With the scarcity of organ donors and the high mortality from waiting lists, it is prudent that we do everything to improve the chances of survival after transplantation. Adolescence is a critical stage in child development where medication non-adherence can be as high as 40-60% This occurs for multiple reasons including biological, psychological, and social developmental issues and is a time when accountability is encouraged shared medical care in collaboration with the caregiver for a successful transition to adulthood where the patient is expected to assume comprehensive care.”
Video recordings for drugs
Gupta and colleagues analyzed data from 10 adolescent heart transplant recipients between the ages of 10 and 21 with a history of medication adherence difficulties but otherwise medically stable. Participants were enrolled in a 12-week single-group pilot study examining the impact of a directly observed treatment (emocha Health) on treatment adherence. The program includes a comprehensive medication review, daily and asynchronous video recordings, dose-by-dose reports, daily engagement via two-way chat or phone, adherence coach, and financial incentive (patients were compensated a maximum of $114 for study participation, including $1 per video submission day and $10 per completed interview).
“Directly observed therapy is a method of monitoring medication adherence by allowing patients to submit videos of themselves taking the medication which are reviewed asynchronously by the monitoring nurse or staff member. ‘transplant team,” Gupta told Healio. “This technology also enables improved patient engagement and positive reinforcement to tackle this difficult problem. The emocha platform and app allows nurses and other members of the transplant team to interact, engage and encourage patients to submit videos, take their medications and internalize the need for monitor their own health behaviors.
The researchers developed an escalation protocol; reasons for escalation included missed doses or video submissions, adverse drug reaction reports, administration issues, urgent patient health and safety issues, and non-adherence behaviors.
Directly observed therapy and mobile app tracked medication use through direct observation; The number of possible doses was compared to the number of videos submitted by patients demonstrating taking the medication.
Researchers also assessed health-related quality of life, measured through questionnaires, as well as barriers to taking medication as prescribed. The researchers also analyzed long-term health outcomes, including acute rejection and hospitalization 6 months after directly observed treatment.
The findings were published in Pediatric transplant.
Better grip, great accessibility
Within the cohort, eight patients completed the intervention. Patients submitted 90.1% of possible videos demonstrating medication doses taken.
Patients and caregivers reported a high perception of acceptability and accessibility. Medication level variability index values for patients initiating directly observed treatment decreased from 6 months before the intervention (mean, 2.86) to 6 months after the intervention (mean, 2.08) , representing a 21.7% decrease in non-adherence. However, the result was not statistically significant due to the small sample size.
The researchers noted that the results provide “significant promising information” regarding the feasibility, acceptability and potential impact of a directly observed treatment as an adherence intervention for adolescent heart transplant recipients.
“With the increasing developments in mobile monitoring technologies, directly observed therapy provides us with an important tool that can help address this difficult problem from a multi-faceted approach” Michael Killian, PhD, MSW, associate professor at Florida State University College of Social Work, Healio told. “Further studies will need to be conducted in a randomized control study to be able to determine the effectiveness of this modality in helping the vulnerable population with chronic conditions such as organ transplantation.”
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