Conventional vs. Tablet Computer-Based Patient Education following Lung Transplantation – A Randomized Controlled Trial

Abstract

BackgroundAccurate immunosuppression is of critical importance in preventing rejection, while avoiding toxicity following lung transplantation. The mainstay immunosuppressants are calcineurin inhibitors, which require regular monitoring due to interactions with other medications and diet. Adherence to immunosuppression and patient knowledge is vital and can be improved through patient education. Education using tablet-computers was investigated.ObjectiveTo compare tablet-PC education and conventional education in improving immunosuppression trough levels in target range 6 months after a single education. Secondary parameters were ratio of immunosuppression level measurements divided by per protocol recommended measurements, time and patient satisfaction regarding education.DesignSingle-centre, open labelled randomised controlled trial.ParticipantsPatients >6 months after lung-transplantation with <50% of calcineurin inhibitor trough levels in target range.InterventionTablet-pc education versus personal, nurse-led education.MeasurementsCalcineurin inhibitor levels in target range 6 months after education, level variability, interval adherence, knowledge and adherence was studied. As outcome parameter, renal function was measured and adverse events registered.ResultsSixty-four patients were 1:1 randomised for either intervention. Levels of immunosuppression 6 months after education were equal (tablet-PC 58% vs. conventional 48%, p = 0.27), both groups improved in achieving a CNI trough level within target range by either education method (delta tablet-PC 29% vs. conventional 20%). In all patients, level variability decreased (−20.4%), whereas interval adherence remained unchanged. Knowledge about immunosuppression improved by 7% and compliance tests demonstrated universal improvements with no significant difference between groups.ConclusionEducation is a simple, effective tool in improving adherence to immunosuppression. Tablet-PC education was non-inferior to conventional education.Trial RegistrationClinicalTrials.gov NCT01398488 http://clinicaltrials.gov/ct2/show/NCT01398488?term=gottlieb+tablet+pc+education&rank=1.

A systematic review of immunosuppressant adherence interventions in transplant recipients: Decoding the streetlight effect

“…Studies were conducted in liver (n = 8), kidney (n = 25), heart or heart/lung (n = 2), and lung transplant recipients (n = 4), as well as mixed groups (n = 2). Of the RCTs, 11 did not report on transplant outcomes, and 10 examined them and found no effect of the intervention . Table is a detailed review of the 10 RCTs that looked at transplant outcomes (and found no intervention effect); this table also presents other outcomes that were examined in those studies.…”

“…Of the RCTs, 11 did not report on transplant outcomes, [45][46][47][48][49][50][51][52][53][54]57 and 10 examined them and found no effect of the intervention. 55,56,[58][59][60][61][62][63][64][65] Table 2 is a detailed review of the 10 RCTs that looked at transplant outcomes (and found no intervention effect); this table also presents other outcomes that were examined in those studies.…”

“…First, this "uncoupling" is true for studies that used indirect adherence measures [38][39][40]56,[58][59][60]62,63,65 (many used electronic monitors 56,58,59,65 ), but was not true in studies that used direct measures that relied on medication blood levels. [25][26][27][28]55,64,65 As shown in Table 1, when medication blood levels (or, the degree of fluctuation between levels) improved, 25,26,28 transplant outcomes improved as well; when levels did not improve, 27,55,64,65 transplant outcomes did not improve, either. We believe that this suggests that direct measures of adherence are better measures of medication intake than indirect measures (indeed, by definition, indirect measures do not actually measure intake).…”

Using Tablet-Based Technology in Patient Education about Systemic Therapy Options for Early-Stage Breast Cancer: A Pilot Study

“…To our knowledge, no previous studies have used tablet-based education in the context of adjuvant breast cancer therapy. A similar intervention was used to educate lung transplant recipients about adherence to immunosuppressive therapy 16 . The primary outcome in that study was treatment adherence (measured by serum drug levels), and the tablet-based education tool was found to be noninferior to conventional nurse-administered teaching, with a trend toward better adherence in patients receiving the tablet-based intervention.…”

Perspectives on implementing mobile health technology for living kidney donor follow‐up: In‐depth interviews with transplant providers

“…Only 43% of centers met reporting thresholds for LKDs who donated in 2013, indicating that novel methods for collecting LKD follow-up data are needed. [10][11][12][13][14][15][16][17][18][19][20] However, mHealth technology has not yet been explored as a method for improving LKD follow-up, despite the well-documented challenges of collecting follow-up data. 9 Within the transplant community, mHealth technologies have been used to address numerous challenges in the field, including educating transplant recipients and candidates, improving adherence and self-management behaviors of recipients, helping patients on the waitlist find a living donor, and aiding in the screening and evaluation process of LKD candidates.…”