Transplant Library

Abstract

BACKGROUND:

In a randomized controlled trial, lung transplant recipients (LTRs) using a mobile health intervention, Pocket Personal Assistant for Tracking Health (Pocket PATH), showed better adherence to the medical regimen than LTRs receiving usual care during the first year posttransplant. We examined whether these effects were maintained beyond the end of the trial and evaluated other potential risk factors for long-term nonadherence.

METHODS:

Adherence in 8 areas was evaluated at follow-up in separate LTR and family caregiver (collateral) assessments. Pocket PATH and usual care groups' nonadherence rates were compared; multivariable regression analyses then examined and controlled for other patient characteristics' associations with nonadherence.

RESULTS:

One hundred five LTRs (75% of survivors) were assessed (M = 3.9 years posttransplant, SD = 0.8). Nonadherence rates in the past month were 23%-81% for self-care and lifestyle requirements (diet, exercise, blood pressure monitoring, spirometry), 13%-23% for immunosuppressants and other medications, and 4% for tobacco use, with 31% clinic appointment nonadherence in the past year. In multivariable analysis, the Pocket PATH group showed lower risk of nonadherence to lifestyle requirements (diet/exercise) than the usual care group (P < 0.05). Younger age and factors during the first year posttransplant (acute graft rejection, chronically elevated anxiety, less time rehospitalized, nonadherence at the final randomized controlled trial assessment) were each associated with nonadherence in at least 1 area at follow-up (P < 0.05).

CONCLUSIONS:

Pocket PATH did not have sustained impact on most areas of the regimen, although we identified other risk factors for long-term nonadherence. Future work should explore strategies to facilitate sustained effects of mobile health interventions.

CET Conclusion

Reviewer:	Dr Liset Pengel, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford
Conclusion:	This is a long-term follow-up analysis of a trial comparing the Pocket PATH, a mobile health intervention targeting adherence, with usual care in adult lung transplant recipients. The 1-year results showed improved overall adherence for patients receiving the Pocket PATH. For the long-term follow-up participants were on average 3.9 years posttransplant. Non-adherence in the previous months was assessed for eight domains, e.g. regarding drug taking but also diet and exercise, using a validated patient and family caregiver report. The analysis included 105 out of the 201 participants in the original trial and only two participants of the original trial were still using the Pocket PATH. There were no significant differences between Pocket PATH and usual care groups for overall adherence or any of the adherence domains. Adherence rates were lower for the long-term follow-up compared to the end of the trial at 12 months. Regression analyses identified potential risk factors of long-term nonadherence to any of the domains that should be considered when addressing long-term adherence.

Reviewer:

Dr Liset Pengel, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford

Conclusion:

This is a long-term follow-up analysis of a trial comparing the Pocket PATH, a mobile health intervention targeting adherence, with usual care in adult lung transplant recipients. The 1-year results showed improved overall adherence for patients receiving the Pocket PATH. For the long-term follow-up participants were on average 3.9 years posttransplant. Non-adherence in the previous months was assessed for eight domains, e.g. regarding drug taking but also diet and exercise, using a validated patient and family caregiver report. The analysis included 105 out of the 201 participants in the original trial and only two participants of the original trial were still using the Pocket PATH. There were no significant differences between Pocket PATH and usual care groups for overall adherence or any of the adherence domains. Adherence rates were lower for the long-term follow-up compared to the end of the trial at 12 months. Regression analyses identified potential risk factors of long-term nonadherence to any of the domains that should be considered when addressing long-term adherence.

Study Details

Aims:	The is a long-term follow-up study of a randomised controlled trial (RCT) which investigated the impact of a mobile health intervention, Pocket Personal Assistant for Tracking Health (Pocket PATH), on adherence of lung transplant recipients (LTRs) to the medical regimen compared LTRs receiving usual care. This study aimed to assess whether the adherence to the medical regimen was sustained beyond the 1-year follow-up period of the original RCT.
Interventions:	Participants were randomised to Pocket PATH or usual care.
Participants:	Lung transplant recipients
Outcomes:	The main outcome was the assessment of nonadherence using the Health Habits Survey. The study assessed nonadherence in 8 different areas including taking the primary immunosuppressant, taking other medications, attending clinic appointments, monitoring of blood pressure, performing home spirometry, following a diet prescription, following an exercise prescription, and abstaining from the use of tobacco.
Follow Up:	4 years (mean)

Metadata

Funding:	Non-industry funding
Publication type:	Randomized Controlled Trial, Randomised Controlled Trial
Trial registration:	ClinicalTrials.Gov - NCT00818025
Organ:	Lung
Language:	English
Author email:	dewma@ upmc.edu
MeSH terms:	Adult; Age Factors; Aged; Female; Follow-Up Studies; Graft Rejection; Humans; Immunosuppressive Agents; Lung Transplantation; Male; Medication Adherence; Middle Aged; Mobile Applications; Reminder Systems; Smartphone; Telemedicine; Transplant Recipients; 0 (Immunosuppressive Agents)

Impact of a Mobile Health Intervention on Long-term Nonadherence After Lung Transplantation: Follow-up After a Randomized Controlled Trial