Directly observed therapy to promote medication adherence in paediatric heart transplant recipients

Killian, Michael; Clifford, Stephanie; Gupta, Dipankar

doi:10.1017/s1047951121002109

Cited by 8 publications

(13 citation statements)

References 10 publications

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“…Future research will need to investigate whether individuals with a high number of barriers, who would likely benefit the most from DEAP, will utilize the platform. Recent research in adolescent heart transplant patients has focused recruitment efforts specifically on those with poor medication adherence (Killian et al, 2021) and these strategies can be applied to research with AYAs who have received kidney transplants. An important next step is to take stakeholder feedback to optimize the DEAP system, including a better user experience, more personalization, and better patient–clinician engagement.…”

Section: Discussionmentioning

confidence: 99%

Development and testing of a digitally enabled adherence platform.

Abelson,

Hooper,

Varnell

et al. 2024

Clinical Practice in Pediatric Psychology

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Objective: To develop a digitally enabled adherence platform (DEAP) using evidence-based adherence promotion strategies through iterative testing with patients, design specialists, and adherence experts. Method: Adolescents and young adults (AYAs) with a kidney transplant from a large, midwestern transplant program were recruited to participate in this study. Through an iterative process, we conducted focus groups, individual interviews, empathy interviews/mapping, and usability testing and evaluation to develop and refine the initial version of DEAP. Results: Three empathy maps were created to assess the unique needs of patients, caregivers, and healthcare providers. Eleven patients were then recruited to participate in usability testing of the platform. Platform engagement was high with nine of the 11 participants viewing their initial messages/surveys, usability was rated as high (M = 81.88, SD = 9.61, range = 67.5–95.0), and user-friendliness was rated as excellent (M = 5.88, SD = 0.74, range = 5.0–7.0). Participants also noted multiple opportunities for improving the look and design of DEAP. Conclusions: Engaging with multiple stakeholders and piloting a small usability study have demonstrated support for the acceptability and usability of DEAP, a mobile health platform to address barriers to taking immunosuppression medication for AYAs who have received kidney transplants. Future work is planned to develop a better patient and clinician user experience, increase personalization, and facilitate patient–clinician engagement using this platform.

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Section: Discussionmentioning

confidence: 99%

Development and testing of a digitally enabled adherence platform.

Abelson,

Hooper,

Varnell

et al. 2024

Clinical Practice in Pediatric Psychology

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“…Upon completion of the 12‐week intervention, patients and caregivers were again contacted, asked to complete the post‐intervention survey, and were debriefed regarding the study. A flow chart detailing the enrollment, trainings, measurement points, and staff responsibilities during the DOT intervention has been previously published 49 …”

Section: Methodsmentioning

confidence: 99%

Directly observed therapy to promote medication adherence in adolescent heart transplant recipients

Killian

Clifford

Lustria

et al. 2022

Pediatric Transplantation

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Purpose: HT recipients experience high levels of medication non-adherence during adolescence.Thispilotstudyexaminedtheacceptabilityandfeasibilityofanasynchro-nousDOTmHealthapplicationamongadolescentHTrecipients.Theappfacilitates trackingofpatients'dose-by-doseadherenceandenablestransplantteammembers toengagepatients.TheDOTapplicationallowspatientstoself-recordvideoswhile takingtheirmedicationandsubmitforreview.Transplantstaffreviewthevideosand communicate with patients to engage and encourage medication adherence. Methods: Ten adolescent HT recipients with poor adherence were enrolled into a single-group, 12-week pilot study examining the impact of DOT on adherence. Secondaryoutcomesincludedself-reportmeasuresfrompatientsandparentsconcerning HRQOL and adherence barriers. Long-term health outcomes assessed in-cludedARandhospitalization6monthsfollowingDOT. Findings: Among14adolescentHTpatientsapproached,10initiatedtheDOTintervention. Of these, 8 completed the 12-week intervention. Patients and caregivers reportedhighperceptionsofacceptabilityandaccessibility.Patientssubmitted90.1% ofpossiblevideosdemonstratingmedicationdosestaken.MLVIvaluesforthe10pa-tientsinitiatingDOTdecreasedfrom6monthspriortotheintervention(2.86± 1.83) to6monthsfollowingtheirinvolvement(2.08±0.87)representinga21.7%decrease innon-adherence,thoughnotstatisticallysignificantgiventhesmallsamplesize. Conclusions: Result of this pilot study provides promising insights regarding the feasibility,acceptability,andpotentialimpactofDOTforadolescentHTrecipients.Further randomizedstudiesarerequiredtoconfirmtheseobservations.

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“…A flow chart detailing the enrollment, training, measurement points, and staff responsibilities during the intervention has been previously published. 18 Sampling A convenience sampling strategy was used to recruit adolescents ages 11 to 21 years from the transplant clinic that had documented evidence or concern for medication nonadherence during routine, outpatient clinic visits. Recipients who had received a heart transplant more than 6 months prior and were otherwise deemed medically stable by the pediatric transplant team were eligible to participate.…”

Section: Settingmentioning

confidence: 99%

Engaging Adolescent Heart Transplant Recipients Through In-App Messaging During Mobile Health Intervention

Killian,

Schelbe,

Lustria

et al. 2023

Prog Transpl

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Introduction: Adolescents heart transplant recipients experience difficulty with adherence to immunosuppressive medication leading to increased risk of organ rejection, hospitalization, and mortality. Few interventions have been successful to promote medication adherence in adolescent heart transplant patients as most fail to engage the patient in the behavioral change process and support patient–provider communication. The purpose of this study was to explore the nature and degree of in-app communication between adolescent heart transplant recipients and nursing staff during an asynchronous mobile video directly observed therapy intervention. Methods: A content analysis of 894 in-app messages exchanged between 10 adolescent patients and nurses during a 12-week mobile-based intervention was conducted. Two authors used an inductive, iterative process to guide a thematic analysis of the asynchronous in-app messages with high interrater reliability ranging from 81.5% to 100%. Findings: In-app messages fell under 3 broad content categories: (1) interpersonal support and rapport-building, (2) medically related questions and information, or (3) functional information about the intervention and the mHealth app. Results demonstrated the degree to which interpersonal engagement occurred during the intervention, the nature of these exchanges, and their relationship to medication adherence. Conclusions: The study provided insights into the feasibility and benefits of 2-way communication features of the directly observed therapy intervention in promoting engagement and in improving medication adherence among adolescent heart transplant patients. Continued research and clinical focus on patient engagement and impactful aspects of interpersonal communication could aid in the translation of this intervention into standard clinical care at pediatric transplant centers.

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Directly observed therapy to promote medication adherence in paediatric heart transplant recipients

Cited by 8 publications

References 10 publications

Development and testing of a digitally enabled adherence platform.

Development and testing of a digitally enabled adherence platform.

Directly observed therapy to promote medication adherence in adolescent heart transplant recipients

Engaging Adolescent Heart Transplant Recipients Through In-App Messaging During Mobile Health Intervention

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