Mobile Health Medication Adherence and Blood Pressure Control in Renal Transplant Recipients: A Proof-of-Concept Randomized Controlled Trial

Abstract

BackgroundMobile phone based programs for kidney transplant recipients are promising tools for improving long-term graft outcomes and better managing comorbidities (eg, hypertension, diabetes). These tools provide an easy to use self-management framework allowing optimal medication adherence that is guided by the patients’ physiological data. This technology is also relatively inexpensive, has an intuitive interface, and provides the capability for real-time personalized feedback to help motivate patient self-efficacy. Automated summary reports of patients’ adherence and blood pressure can easily be uploaded to providers’ networks helping reduce clinical inertia by reducing regimen alteration time.ObjectiveThe aim of this study was to assess the feasibility, acceptability, and preliminary outcomes of a prototype mobile health (mHealth) medication and blood pressure (BP) self-management system for kidney transplant patients with uncontrolled hypertension.MethodsA smartphone enabled medication adherence and BP self-management system was developed using a patient and provider centered design. The development framework utilized self-determination theory with iterative stages that were guided and refined based on patient/provider feedback. A 3-month proof-of-concept randomized controlled trial was conducted in 20 hypertensive kidney transplant patients identified as non-adherent to their current medication regimen based on a month long screening using an electronic medication tray. Participants randomized to the mHealth intervention had the reminder functions of their electronic medication tray enabled and received a bluetooth capable BP monitor and a smartphone that received and transmitted encrypted physiological data and delivered reminders to measure BP using text messaging. Controls received standard of care and their adherence continued to be monitored with the medication tray reminders turned off. Providers received weekly summary reports of patient medication adherence and BP readings.ResultsParticipation and retention rates were 41/55 (75%) and 31/34 (91%), respectively. The prototype system appears to be safe, highly acceptable, and useful to patients and providers. Compared to the standard care control group (SC), the mHealth intervention group exhibited significant improvements in medication adherence and significant reductions in clinic-measured systolic blood pressures across the monthly evaluations. Physicians made more anti-hypertensive medication adjustments in the mHealth group versus the standard care group (7 adjustments in 5 patients versus 3 adjustments in 3 patients) during the 3-month trial based on the information provided in the weekly reports.ConclusionsThese data support the acceptability and feasibility of the prototype mHealth system. Further trials with larger sample sizes and additional biomarkers (eg, whole blood medication levels) are needed to examine efficacy and effectiveness of the system for improving medication adherence and blood pressure control after kidney transplantation ov...

Persuasive Systems Design features in Promoting Medication Management for consumers

“…The effectiveness and outcomes of these studies need to be further investigated in the future. However, usability, effectiveness and improved medication adherence have also been reported in the some of the articles reviewed [10,12,13,[15][16][17] and that reinforces the support of PSD features in consumer behaviour change perspectives. It was also reported in the studies that computer-based intervention motivated the participants to be more involved in their health management and the aware of their disease [20].…”

“…Nine of the 13 articles reviewed, included aspects that related to the principle of reminders [9,[12][13][14][15][16][17][18]21]. Reminders were included as: auditory signals and visual notifications to prompt daily self-assessment task [9,16] medication reminders when patients have forgotten [12,15]; as well as SMS's for medication dosage and times [13].…”

“…Reminders were included as: auditory signals and visual notifications to prompt daily self-assessment task [9,16] medication reminders when patients have forgotten [12,15]; as well as SMS's for medication dosage and times [13]. In some cases, the program only provided reminders while the patient was using the system and the MyMediHealth medication management system [21] sent text message reminders to patients containing a webpage link to record if the medication was taken [21].…”

Rates and Predictors of Uncontrolled Hypertension Among Hypertensive Homeless Adults Using New York City Shelter-Based Clinics

“…Considering the mobile nature of the homeless populations and their lack of consistent housing, mobile health strategies (the delivery of health care services via mobile communication devices), which have been used in the general population to improve the management of chronic diseases with reminders and health education for diet and exercise, may be effective and should be explored. [27][28][29][30][31][32][33] Providing opportunities at shelters or shelter-based clinics where the homeless often seek care and where they have access to other social and system supports could address the multilevel barriers to hypertension control. These opportunities would adopt the elements of the chronic care model, which include targeted outreach to support health behavior change, collaborative goal setting, and reminders and feedback that empower patients.…”

Present and Future Trends in Consumer Health Informatics and Patient-Generated Health Data

“…The increasing access and connection between clinics and homes have indicated new opportunities in bridging the gaps. Better interpretations of patient data for the patients are expected to provide better connections to user's internal motivators for sense-making and persuasion [54][55][56]. This will then allow the adoption of a positive psychology and help the target users to focus on their own reason for goal attainment.…”