Video therapy improves medication adherence for adolescent heart transplant recipients
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A digital medication adherence program with virtual video check-ins was associated with adolescent heart transplant recipients taking more of their medications as prescribed 6 months after the intervention, data from a pilot study show.
“Medication nonadherence is a significant problem which can lead to graft failure and patient mortality,” Dipankar Gupta, MBBS, DCH, MD, assistant professor of pediatric cardiology at the Congenital Heart Center at UF Health Shands Children’s Hospital, University of Florida, told Healio. “With paucity of organ donors and high waitlist mortality, it is prudent that we do everything to improve the chances of post-transplant survival. Adolescence is a critical stage in child's development where medication nonadherence can be as high as 40% to 60%. This happens due to multiple reasons, including biological, psychological and social developmental challenges. Additionally, this is a period where there is encouragement of shared responsibility of medical care in conjunction with the caregiver for a successful transition to adulthood where the patient is expected to assume complete care."
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Video check-ins for medication
Gupta and colleagues analyzed data from 10 adolescent heart transplant recipients aged 10 to 21 years with a history of difficulties with medication adherence but otherwise medically stable. Participants were enrolled into a single-group, 12-week pilot study examining the impact of directly observed therapy (emocha Health) on medication adherence. The program includes a comprehensive medication review, daily, asynchronous video check-ins, dose-by-dose reporting, daily engagement via two-way chat or phone, an adherence coach and a financial incentive (patients were compensated a maximum of $114 for study participation, including $1 per day of video submission 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 asynchronously reviewed by the monitoring nurse or transplant team member,” Gupta told Healio. “This technology also allows improved patient engagement and positive reinforcement in order to tackle this difficult problem. The emocha platform and app allows for nurses and other transplant team members to interact, engage and encourage patients to submit videos, take their medication and internalize the need to monitor their own health behaviors.”
Researchers developed an escalation protocol; reasons for escalation included missed doses or video submissions, reports of adverse effects from medication, administration problems, urgent patient health and safety concerns and nonadherence behaviors.
Directly observed therapy and the mobile app tracked medication taking through direct observation; number of possible doses were compared with the number of videos patients submitted that demonstrated medication taking.
Researchers also assessed health-related quality of life, measured via questionnaires, as well as barriers to taking medications as prescribed. Researchers also analyzed long-term health outcomes, including acute rejection and hospitalization 6 months after directly observed therapy.
The findings were published in Pediatric Transplantation.
Improved adherence, high accessibility
Within the cohort, eight patients completed the intervention. Patients submitted 90.1% of possible videos demonstrating medication doses taken.
Patients and caregivers reported high perceptions of acceptability and accessibility. Medication-level variability index values for patients initiating directly observed therapy 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 nonadherence. However, the finding was not statistically significant due to the small sample size.
The researchers noted the findings provide “important promising insights” regarding the feasibility, acceptability and potential impact of directly observed therapy as an adherence intervention for adolescent heart transplant recipients.
“With increasing developments in mobile monitoring technologies, directly observed therapy provides us an important tool which can help tackle this difficult problem from a multifaceted approach” Michael Killian, PhD, MSW, associate professor at Florida State University College of Social Work, told Healio. “Further studies will need to be conducted in a randomized control study to be able to ascertain the effectiveness of this modality in helping the vulnerable population with chronic problems like organ transplantation.”
For more information:
Dipankar Gupta, MBBS, DCH, MD, can be reached at dgupta@ufl.edu. Michael Killian, PhD, MSW, can be reached at mkillian@fsu.edu.
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