Mobile Technology and Medication Adherence in Renal Transplantation

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Mobile Technology and Medication Adherence in Renal Transplantation

SubtitlePresenters

Date

John W McGillicuddy, MD

Martina Mueller, PhD Gayenell S Magwood, PhD, RN Signe Denmark, MS Ronja Frenzel, BSAna Weiland, BS Frank A Treiber, PhDSachin Patel, MSc Brenda Brunner-Jackson, MPH

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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

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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

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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

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SURVEY: Demographics

Mean age: 52 years Male sex: 64%

Ethnicity: 62% AA 1st transplant: 89%

Income: 60%* @ <$30,000 Travel time: 75% travel >1h

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SURVEY: Results• Adherence is a real problem for our patients

• 74% reported at least some difficulty with medication adherence based on a 7-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

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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

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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

Pilot RCT• Utilize wireless technology to identify nonadherent

patients and interact with them in real time:

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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

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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

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Outcome Measures

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Study Design and Methods

Alert IndicatorsFlashing LightChimeCell phone call

MedMinder Processing Center

Microsoft HealthVault

Adherence Coach

AND BP Monitor

MedMinderMedication Reminder Device

Android Phone

Healthcare Provider

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Where Are We?

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Questions?