Randomized Controlled Trial of a Computer-Based Education Program in the Home for Solid Organ Transplant Recipients: Impact on Medication Knowledge, Satisfaction, and Adherence
De novo solid organ transplant recipients (SOTR) have a steep learning curve to acquire medication knowledge. Without adequate knowledge, SOTR are at risk of nonadherence and poor transplant outcomes.
METHODS:In this nonblinded, randomized controlled trial, de novo SOTR received standard teaching with or without postdischarge computer-based education (CBE) at home. Primary outcomes were change in knowledge (quiz and recall) and satisfaction, assessed by questionnaires at baseline and 3 months. Adherence was evaluated via self-report and immunosuppressant levels.
RESULTS:Two hundred forty-six patients were randomized and 209 completed the 3-month analysis. In the intervention arm, 73 (57.9%) used the CBE program. Change in knowledge quiz score did not differ between groups (4.9% vs 0.6%; P = 0.084), despite a significant increase within the intervention (72.4% vs 77.3%, P = 0.007) but not the control (76.0% vs 76.6%, P = 0.726) arms. Both groups had a significant improvement in recall (intervention, 56.7% vs 82.1%, P < 0.001; control, 51.3% vs 79.7%, P < 0.001), with similar changes in scores (25.4% vs 28.4%, P = 0.55). Change in satisfaction differed between groups (intervention, 1.2% vs control, -4.9%; P = 0.050). There was a significant decline in satisfaction within the control group (88.4% vs 83.5%, P = 0.035), whereas satisfaction was maintained with the intervention (85.6% vs 86.8%, P = 0.55). Adherence was similar in both groups.
CONCLUSIONS:Knowledge improved over the study period in both groups, with no incremental benefit for the intervention. Patient satisfaction was maintained with the CBE program. More research is needed to identify barriers to uptake of CBE at home and to develop effective strategies for posttransplant education.
CET Conclusion
| Reviewer: | Centre for Evidence in Transplantation |
|---|---|
| Conclusion: | De novo solid organ transplant recipients who had received standard, in-hospital, pharmacy-led self-medication teaching were randomised to receive additional computer-based education or no additional education. Power calculations showed that 110 patients per study arm were needed. The study randomised 246 patients using concealed allocation and 209 patients were included in the 3-month analysis. There were no differences between groups at 3 months in terms of medication knowledge, satisfaction with the medication information provided and medication adherence indicating that the computer-based education did not provide additional value to the standard, in-hospital self-medication programme alone. |
Expert Review
| Reviewer: | Ms Teresa Shafer, Progress in Transplantation, Fort Worth, TX, USA |
|---|---|
| Conflicts of Interest: | No |
| Clinical Impact Rating | 2 |
| Review: | Knowledge and administration of medications is central to post-transplant outcomes. Post-transplant education to ensure mastery of such knowledge in order to maintain the graft has always been a part of patient treatment and a bane to transplant professionals so charged with the task. The article by Harrison and colleagues measures the efficacy of a computer based education (CBE) at home against the standard in-clinic/office setting by the practitioner. Randomized solid organ transplant recipients at this single center trial were sorted into a standard educational arm and an intervention arm that added CBE in the home. The study found no difference in outcomes between the control or standard group and the intervention group receiving CBE. While the study identified no silver bullets to the current labor intensive and costly provision of such education by skilled transplant practitioners in the standard setting, it served a valuable purpose in providing the first RCT evaluation of such an intervention. The study reinforces the reality that transplantation is highly specialized, hands-on and dependent on heavy involvement of skilled practitioners not only in the operating room but in the post-transplant phase when maintenance of the graft assumes center stage. There appear to be no shortcuts here and we benefit from their well-designed study to say so. |
Methodological quality
| Jadad score | 3 |
|---|---|
| Allocation concealment | YES |
| Data analysis | AVAILABLE CASE ANALYSIS |
| Research notes | Dr Jennifer Harrison provided the additional details that a patients for whom the outcome was obtained were analyzed according to their assigned group. Patients in the intervention group were analyzed as such, regardless of whether or not they actually received the intervention. |
Study Details
| Aims: | To evaluate the impact of a home delivered computer-based education (CBE) program on medication knowledge, satisfaction and immunosuppressant adherence in de novo solid organ transplant recipients (SOTR). |
|---|---|
| Interventions: | Participants were randomised to receive either the standard of care (control group), or the standard of care plus the Transplant Medication Information Teaching Tool (TMITT) as an online CBE program (intervention group). |
| Participants: | 246 SOTR. |
| Outcomes: | The primary outcomes measured were change in knowledge and satisfaction. The secondary measured outcome was adherence to the immunosuppressive regimen. |
| Follow Up: | 3 months |
Metadata
| Funding: | Industry funding |
|---|---|
| Publication type: | Randomized Controlled Trial, Randomised Controlled Trial |
| Trial registration: | ClinicalTrials.gov -NCT01826721 |
| Organ: | Various |
| Language: | English |
| MeSH terms: | Adult; Computer-Assisted Instruction; Female; Health Knowledge, Attitudes, Practice; Health Literacy; Humans; Male; Mental Recall; Middle Aged; Ontario; Organ Transplantation; Patient Compliance; Patient Education as Topic; Patient Satisfaction; Prospective Studies; Self Care; Surveys and Questionnaires; Time Factors; Transplant Recipients; Treatment Outcome |