Acceleration of mobile health for monitoring post‐transplant in the COVID‐19 era: Applications for pediatric settings

Abstract

Background Since the start of the COVID‐19 pandemic and consequent lockdowns, the use of telehealth interventions has rapidly increased both in the general population and among transplant recipients. Among pediatric transplant recipients, this most frequently takes the form of interventions on mobile devices, or mHealth, such as remote visits via video chat or phone, phone‐based monitoring, and mobile apps. Telehealth interventions may offer the opportunity to provide care that minimizes many of the barriers of in‐person care. Methods The present review followed the PRISMA guidelines. Sources up until October 2020 were initially identified through searches of PsycInfo ® and PubMed ® . Results We identified ten papers that reported findings from adult interventions and five studies based in pediatrics. Eight of the adult publications stemmed from the same two trials; within the pediatric subset, this was the case for two papers. Studies that have looked at mHealth interventions have found high acceptability rates over the short run, but there is a general lack of data on long‐term use. Conclusions The literature surrounding pediatric trials specifically is sparse with all findings referencing interventions that are in early stages of development, ranging from field tests to small feasibility trials. The lack of research highlights the need for a multi‐center RCT that utilizes robust measures of medication adherence and other outcome variables, with longer‐term follow‐up before telehealth interventions should be fully embraced.

Directly observed therapy to promote medication adherence in adolescent heart transplant recipients

“…Overall, adolescents and their parents reported positive perceptions of the DOT similar to other studies of mHealth and telehealth approaches with similar samples of patients 73 …”

The effects of COVID‐19 on pediatric and adult solid organ transplant recipients and the emergence of telehealth

“…A detailed explanation of the inclusion/exclusion process can be found in Figure 17 (PRISMA fig). A total of 12 studies [50][51][52][53][54][55][56][57][58][59][60][61] were conducted in the adult population, and 1 study focused on children 62 with a total of 2216 telehealth consultations. As there were a limited number of studies with consistent outcomes measures of telehealth, pooled analysis could not be performed.…”

“…As there were a limited number of studies with consistent outcomes measures of telehealth, pooled analysis could not be performed. Overall, there were 4/13 studies that reported high medical adherence rate (>70%), [50][51][52]61 6/13 studies reported excellent or high satisfaction rates from both patients and physicians, [53][54][55][56]60,62 and 2/13 studies highlighted the ability to obtain accurate BP, weight, and other measurements (77.45%). 57,63 With most consultation appointments able to be conducted virtually, only a handful of patients needed in-person followup visitations, specifically 33/197 patients (two studies).…”

“…Thirteen studies focused on the delivery of post‐transplant care by telehealth suggest increased medical adherence, higher satisfaction rates, and increased ability to obtain measurements (weight, BP, etc.) 50–58,61–63,81 . Telehealth has been shown to facilitate creation of an enduring long‐term relationship between patients and physicians, which can promote self‐management, increased flexibility in healthcare, and thus better individualized care resulting in higher medical adherence rates 82 …”

“…Most health centers used telehealth in post‐transplant care for immunosuppressant medication adherence, waitlist evaluation, and monitoring of health status. There were significant improvements in all categories, as multiple studies reported increased medication adherence, improved quality and efficiency in transplant waitlist evaluation, and more efficient health status monitoring 50,51,55,57,61,63 …”