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Mobile Technology and Medication Adherence in Renal Transplantation

Mobile Technology and Medication Adherence in Renal Transplantation. John W McGillicuddy, MD Martina Mueller, PhD Gayenell S Magwood , PhD, RN Signe Denmark, MS Ronja Frenzel, BS Ana Weiland, BS Frank A Treiber, PhD Sachin Patel, MSc Brenda Brunner-Jackson, MPH. Subtitle

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Mobile Technology and Medication Adherence in Renal Transplantation

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  1. Mobile Technology and Medication Adherence in Renal Transplantation John W McGillicuddy, MD Martina Mueller, PhDGayenellS Magwood, PhD, RN Signe Denmark, MS Ronja Frenzel, BS Ana Weiland, BS Frank A Treiber, PhD Sachin Patel, MSc Brenda Brunner-Jackson, MPH • Subtitle • Presenters • Date http://sctr.musc.edu 843-792-8300

  2. Rationale • ESRD afflicts more than 500,000 people in the USA at cost of more than $29,000,000,000/year • Kidney transplantation offers better quality of life and longer life expectancy than chronic dialysis at a significantly lower cost • Despite significant advances, average graft survival is suboptimal at only 9 years • Kidneys are an incredibly scarce resource which mandates that their use be optimized • Graft survival is worse among African-Americans and those of lower socioeconomic status http://sctr.musc.edu 843-792-8300

  3. Rationale • Medication nonadherence is key contributor to premature graft loss • Approximately 35% of renal transplant patients are nonadherent • Nonadherence contributes to graft loss by allowing for immune mediated rejection and the deleterious effects of poorly controlled comorbid conditions (i.e., HTN) • Mobile health (mHealth) technology has the potential to positively impact medication adherence and thereby improve graft survival http://sctr.musc.edu 843-792-8300

  4. Acceptability • Little is known about renal transplant patients’ attitudes toward mHealth technology • To determine our patients’ attitudes toward mHealth and their willingness and ability to use the technology, a survey of kidney transplant recipients was undertaken • 105 patients were surveyed in our kidney transplant clinic after being given a demonstration of a prototype mHealth system http://sctr.musc.edu 843-792-8300

  5. SURVEY: Demographics Mean age: 52 years Male sex: 64% Ethnicity: 62% AA 1st transplant: 89% Income: 60%* @ <$30,000 Travel time: 75% travel >1h http://sctr.musc.edu 843-792-8300

  6. SURVEY: Results • Adherence is a real problem for our patients • 74% reported at least some difficulty with medication adherence based on a7-item Modified Morisky Scale • Use of health aides at home is high • 85% were using home BP cuff/monitor • 63% were using medication dispensing device • Mobile phones technology is nearly ubiquitous • 90% have mobile phones • 52% have “smart” mobile phones http://sctr.musc.edu 843-792-8300

  7. SURVEY: Results • A mere 7% had any prior knowledge of mHealth technology • Only 6% were uncomfortable with being monitored using mHealth technology • 23% were concerned about the adequacy of privacy protection http://sctr.musc.edu 843-792-8300

  8. SURVEY: Results • 82% felt that mHealth technology would help them better follow their MD’s directions • 85% felt that the technology would enable their MDs to make changes more quickly • 87% agreed that mHealth technology would improve communication between MD and patient • ✔Provided free use, 80% responded that they would use the system http://sctr.musc.edu 843-792-8300

  9. Pilot RCT • Utilize wireless technology to identify nonadherent patients and interact with them in real time: •  •  http://sctr.musc.edu 843-792-8300

  10. Study Design and Methods • Type: Pilot RCT • Subjects: 20 nonadherent kidney transplant patients • Methods: • Group A: standard post operative care • Group B:mHealth program: wireless real time medication reminders, blood pressure monitoring, cognitive behavior adherence skills program http://sctr.musc.edu 843-792-8300

  11. Study Design and Methods • Technology • Maya to monitor and aid in medication adherence • Bluetooth enabled Fora D15b to measure and record BP • “Smart” phones for signal transmission • “Smart” phones for patient interaction • Cognitive behavioral enhancement techniques via video conferencing with adherence coach http://sctr.musc.edu 843-792-8300

  12. Outcome Measures http://sctr.musc.edu 843-792-8300

  13. Study Design and Methods http://sctr.musc.edu 843-792-8300

  14. Where Are We? http://sctr.musc.edu 843-792-8300

  15. Questions? http://sctr.musc.edu 843-792-8300

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