Digital medicine program with pediatric solid organ transplant patients: Perceived benefits and challenges

Abstract

Given the complexity of the pediatric post‐transplant medication regimen and known medication adherence difficulties within the solid organ transplant population, interventions to improve adherence continue to be explored and fine‐tuned. Advances in technology have led to the development of new programs aimed at improving medication adherence and the overall care of transplant patients. This manuscript describes implementation of a DMP where transplant patients' medications were co‐encapsulated with ingestible sensors, and adherence was monitored via a patient mobile application and a provider portal. The benefits and challenges of the DMP as reported by patients, caregivers, and medical providers are explored in this manuscript. Participant feedback regarding best practices highlighted these benefits: ease of use/intuitive technology, sense of improved communication with medical team, increased knowledge and motivation around treatment regimen, and positive self‐reports of medication adherence. Challenges included reluctance to participate (n = 43, 54.43% of patients approached declined participation) and patch wearability difficulties reported by participants (n = 20; 68.97%). Other notable challenges included the following: limited drug profile compatibility with the DMP technology and concerns about privacy and electronic data sharing for patients who chose not to participate. DMP implementation highlighted how technological advances offer novel methods to assess adherence, enhance medical decision‐making, and can potentially improve clinical outcomes. Although numerous benefits of the program were recognized by participants, challenges were identified and the DMP technology and medication panel continues to be refined; further investigation of such programs continues to be warranted.

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

“…Another study utilized a mHealth application in conjunction with other forms of digital medicine: a wearable patch and an ingestible sensor pill that relayed health information to the app and care team. 17 The study showed promise in terms of positive patient satisfaction with the intervention and positive self‐reports of medication adherence. However, there were extremely high levels of attrition for a multitude of reasons, including irritability from the skin patch.…”

“…However, there were extremely high levels of attrition for a multitude of reasons, including irritability from the skin patch. 17 Another intervention developed is the TRU‐PBMT App, which is used in conjunction with an apple watch in order to monitor patient symptoms. 18 The TRU‐PBMT intervention is currently being studied for feasibility, acceptability, and usability.…”

“…Studies have found high acceptability rates over the short run, but findings to date are drawn from a handful of studies that may not generalize well given design considerations and short follow‐up or, reliance on self‐report measures rather than actual use metrics. In both adult and pediatric trials, findings were reported in the context of small sample sizes 13 , 14 , 17 , 19 , 24 and a lack of long‐term outcomes. 12 , 13 , 14 , 16 , 17 , 24 Additionally, almost all trials were single‐center trials, which may result in patient homogeneity in terms of race and socioeconomic status and consequently a lack of generalizability.…”

E-Health Practices and Technologies: A Systematic Review from 2014 to 2019

“…Regarding the countries that currently use e-health, we identified the following countries where studies have been conducted: United States, Canada, Australia, Germany, Sub-Saharan Africa, Africa, Netherlands, Sweden, Switzerland, China, Italy, Greece, Finland, Iran, Iraq, Bangladesh, Pakistan, Saudi Arabia, United Kingdom, Spain, France, Italy, and Portugal. Some of the studies evaluate more than one type of issue, for instance, diabetes mellitus (DM), cardiovascular diseases, and chronic lung diseases [39]; mental illnesses such as depression, anxiety, dementia [76]; others, such as the oral health of pregnant women in prenatal care, anti-smoking, organ transplants [88]; cancer, such as breast cancer, skin cancer, and lung cancer [77]; eating disorders, including care regarding infant nutrition, diabetes, and obesity in adults [75]; chronic illness, such as chronic inflammatory rheumatic diseases (CIRDs), asthma, and chronic pain [10]; cardiovascular diseases [89]; cerebrovascular accident (CVA), coronary artery disease, and atrial fibrillation (AF) [90]; sexually transmitted diseases (STDs), such as HIV and/or sexually transmitted infections (STIs) [50]; human papillomavirus (HPV) and child sexual abuse [91].…”

eHealth in transplantation

“…[56] compared tacrolimus levels before and after online sessions on medical adherence but did not find differences. The use of digital pharmaceutics with an ingestible sensor is a novel approach [57] to directly measure drug adherence. After ingestion together with medication, the sensor is activated in the stomach and transmits a signal to the smartphone via a patch on the skin [58].…”