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

Abstract

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.

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

“…The volume of and popularity of in-app messaging implies positive perceptions about the 2-way communication and support features of the mHealth app. This finding was further bolstered by the previously reported results of the pilot study 19 that showed patients who completed the 12-week protocol submitted 1211 videos of a possible 1344-demonstrating a 90.1% adherence rate. This adherence rate would have been approximately 82.9% if the videos not submitted by the 2 patients who dropped out from the study prematurely in the third week had been counted.…”

“…This mHealth intervention 18,19 was unique because it included features and functionalities that target multiple and modifiable risk factors for nonadherence and promote sustained behavioral change. 9,12,21 Previous studies involving mHealth interventions for pediatric transplant patients have mainly focused on the delivery of notifications as reminders to take medications, often in the form of an alarm on a mobile phone or other smart device.…”

“…The content analysis of in-app messages exchanged between patients and nursing staff offers an in-depth and rich exploration of an innovative 2-way communication feature of the intervention and demonstrated the degree to which interpersonal engagement occurred during the intervention, the nature of these exchanges, and its relationship to medication adherence. This mHealth intervention 18,19 was unique because it included features and functionalities that target multiple and modifiable risk factors for nonadherence and promote sustained behavioral change. 9,12,21 Previous studies involving mHealth interventions for pediatric transplant patients have mainly focused on the delivery of notifications as reminders to take medications, often in the form of an alarm on a mobile phone or other smart device.…”

“…The study was a content analysis of adolescent heart transplant recipients' and nursing staff's engagement during the prospective, single-group pilot of the 12-week asynchronous directly observed mHealth intervention. 19 The University Institutional Review Board reviewed and approved the study (Study #IRB202000695).…”

“…The directly observed mHealth intervention was successfully implemented and piloted with adolescent heart transplant patients from a children's hospital in the southeastern United States, wherein patients and their caregivers reported high levels of intervention acceptability 18,19 Ten adolescent transplant recipients recruited from a large pediatric heart transplant program received the mHealth intervention with 8 completing the 12-week protocol. Specifically, the study involved adolescent heart transplant recipients who exhibited poor medication adherence.…”