Cell phone support to improve medication adherence among solid organ transplant recipients

Abstract

For many adolescent and young adult solid organ transplant recipients, medication non-adherence is a mortal issue. This study investigated the feasibility, acceptability, and potential efficacy of a 12-week cell phone support intervention to improve immunosuppressant medication adherence. A small sample (N = 8) of non-adherent adolescent and young adult transplant recipients, aged 15-20.5 years, was enrolled. Cell phone support consisted of short calls each weekday including medication reminders, discussion of needs, problem-solving support, and promotion of clinic and community resources. Changes in adherence were measured by self-report and laboratory values, and intervention acceptability, adherence barriers, social support, depression, and substance use were assessed by self-report. Pre-post effect sizes showed medium-to-large improvements in adherence, lasting through a 12-week follow-up assessment. There were also small-to-medium changes in adherence barriers, social support, and depression. However, acceptability and feasibility were limited, due to a low rate of enrollment by eligible male participants. Cell phone support interventions may promote medication adherence among adolescents and young adults. Cell phone support warrants further investigation, including a randomized controlled trial to evaluate efficacy.

Empowering patients to adhere to their treatment regimens: A multifaceted approach

“…The study included a once a week call by a trained adherence facilitator to address adherence barriers and facilitate problem‐solving and identify resources. Of 17 patients identified as eligible, only nine (52.9%) consented to participate despite a financial incentive and limited time burden, and only eight completed the intervention 36 . The Sayegh study illustrates the real day‐to‐day challenges of maintaining engagement of our non‐adherent adolescents in behavior change.…”

Beyond Survival in Solid Organ Transplantation: A Summary of Expert Presentations from the Sandoz 6th Standalone Transplantation Meeting, 2018

“…71,72 Randomized trials that investigate multicomponent interventions incorporating socioeconomic-, treatment-, condition-, and patient-related factors are needed. 71 Pilot studies investigating the implementation of a peer mentoring program, 73 group meetings, 74 and daily phone reminders 75 in adolescent transplant recipients have shown promise and warrant further evaluation.…”

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

“…These are patients already demonstrating challenges with the treatment regimen, so attrition at this rate and attrition among the most non‐adherent patients was expected. A meta‐analysis of mHealth approaches with patients experiencing chronic illness reported an aggregated attrition rate of 43% across studies 45,74 . Other mHealth intervention pilot studies targeting non‐adherence in pediatric transplantation have reported similar high levels of attrition 75 .…”

“…A meta-analysis of mHealth approaches with patients experiencing chronic illness reported an aggregatedattritionrateof43%acrossstudies. 45,74 OthermHealth interventionpilotstudiestargetingnon-adherenceinpediatrictransplantation have reported similar high levels of attrition. 75 Patients withnon-adherencearelesslikelytoberecruitedintoresearch, 72,76 and recruiting only adherent patients with more consistent clinical attendanceleavesmanystudiesunabletoexaminetheimpactofthe interventions aiming to promote medication adherence.…”