Implementing a Home-Based Telehealth Group Adherence Intervention with Adolescent Transplant Recipients

Abstract

Introduction: To improve access to care and engage adolescent transplant recipients for adherence-promoting interventions, innovative solutions utilizing technology are needed. Materials and Methods: This study describes the implementation of a five-session group intervention targeting medication adherence in adolescent transplant recipients through home-based telemedicine. Results: Seven videoconferencing groups were conducted with a total of 33 participants living a median of 57 miles away from their transplant medical center. The median coefficient of variation (CV) of tacrolimus (immunosuppression medication) decreased from 32.2% to 23.5% from the pregroup to postgroup phase. Analyses indicated that the group was acceptable and engaging for participants, as highlighted by one participant reporting, ''I liked how me and the group members came together. it felt like a little family.'' Overall satisfaction with the group and with the technology was endorsed by 86%. The group intervention was generally feasible; however, there were technological difficulties reported by participants and the facilitator, particularly given the diversity of the home-based connections and equipment. Other adaptations helped improve recruitment, attendance, and participation. Discussion: Implementing a telehealth group can pose unique challenges, especially with a group of adolescent participants. Although nonsignificant, we observed a decrease in the median CV of tacrolimus, indicating that medication adherence generally improved after group intervention. Our experience facilitating these groups provides insights into strategies to optimize feasibility and the participant experience. Distance of participants from the hospital is an important consideration and provides a strong rationale for the need for telemedicine-enabled approaches. We explore and discuss the challenges to implementing a home-based group, suggest practical strategies and developmentally sensitive adjustments when working with adolescents, and propose strategies to prepare clinicians for obstacles that may present when implementing a telehealth group with youth.

Empowering patients to adhere to their treatment regimens: A multifaceted approach

“…Kelly SL et al recently reported on a home‐based telehealth group adherence intervention conducted to overcome distance barriers. Adolescent heart, kidney, and lung transplant recipients aged 13‐17 years engaged in videoconferencing groups 34 . Participants lived a median of 57 miles away from their transplant medical center.…”

“…A few recent studies suggest novel approaches to model healthcare system infrastructure to support adherence and illustrate some challenges with feasibility and effectiveness.Kelly SL et al recently reported on a home-based telehealth group adherence intervention conducted to overcome distance barriers. Adolescent heart, kidney, and lung transplant recipients aged 13-17 years engaged in videoconferencing groups 34. Participants lived a median of 57 miles away from their transplant medical center.…”

eHealth in transplantation

“…Kelly et al . [56] compared tacrolimus levels before and after online sessions on medical adherence but did not find differences. The use of digital pharmaceutics with an ingestible sensor is a novel approach [57] to directly measure drug adherence.…”

“…Recruitment, training, and communication with patients rely on the medical staff and their willingness, enthusiasm, and time. Technical problems might occur because of hardware or software issues, and user errors are observed [44,56]. The need for additional help at home for hookup and function was observed in 32% of patients, despite extensive teaching in the hospital.…”

Adherence to Medication During Transition to Adult Services

“…A different way to use technology is to use remote connection to a healthcare provider (similar to telehealth visits). This option has not been sufficiently studied, but a recent study showed a nonsignificant improvement in adherence in adolescent transplant recipients who participated in a video-enabled group intervention [62].…”