Impact of a Mobile Health Intervention on Long-term Nonadherence After Lung Transplantation: Follow-up After a Randomized Controlled Trial

Abstract

Background. In a randomized controlled trial, lung transplant recipients (LTRs) using a mobile health intervention, Pocket Personal Assistant for Tracking Health (Pocket PATH), showed better adherence to the medical regimen than LTRs receiving usual care during the first year posttransplant. We examined whether these effects were maintained beyond the end of the trial and evaluated other potential risk factors for long-term nonadherence. Methods. Adherence in 8 areas was evaluated at follow-up in separate LTR and family caregiver (collateral) assessments. Pocket PATH and usual care groups’ nonadherence rates were compared; multivariable regression analyses then examined and controlled for other patient characteristics’ associations with nonadherence. Results. One hundred five LTRs (75% of survivors) were assessed (M = 3.9 years posttransplant, SD = 0.8). Nonadherence rates in the past month were 23%–81% for self-care and lifestyle requirements (diet, exercise, blood pressure monitoring, spirometry), 13%–23% for immunosuppressants and other medications, and 4% for tobacco use, with 31% clinic appointment nonadherence in the past year. In multivariable analysis, the Pocket PATH group showed lower risk of nonadherence to lifestyle requirements (diet/exercise) than the usual care group (P < 0.05). Younger age and factors during the first year posttransplant (acute graft rejection, chronically elevated anxiety, less time rehospitalized, nonadherence at the final randomized controlled trial assessment) were each associated with nonadherence in at least 1 area at follow-up (P < 0.05). Conclusions. Pocket PATH did not have sustained impact on most areas of the regimen, although we identified other risk factors for long-term nonadherence. Future work should explore strategies to facilitate sustained effects of mobile health interventions.

Mobile medication manager application to improve adherence with immunosuppressive therapy in renal transplant recipients: A randomized controlled trial

“…The importance of patient engagement in mobile health intervention was also shown in a long-term follow-up study [35] of a recent randomized controlled trial evaluating the PocketPATH mobile app, which was designed to promote self-management for lung transplantation patients [36]. Despite a significant increase in short-term self-management behavior in the original study, there was no significant difference in most nonadherence elements in the follow-up study [35].…”

“…Despite a significant increase in short-term self-management behavior in the original study, there was no significant difference in most nonadherence elements in the follow-up study [35]. The authors speculated that the lack of sustained effect is likely to be related to a high rate of discontinuation of app use [35].…”

Evaluation of a Home Monitoring Application for Follow Up after Lung Transplantation—A Pilot Study

“…Good adherence to home monitoring after lung transplantation is associated with better patient and graft survival; however, previous studies have shown that adherence decreases over time [ 4 , 6 , 14 , 15 ]. Although this could not be directly evaluated with our current study design, it is likely that patient adherence to home spirometry increases with the online monitoring of home measurements by the transplant team.…”

“…The patients evaluated a new online home monitoring application and provided suggestions for improvement to specifically tailor the application for lung transplant recipients. As also suggested by Geramita et al, an application specifically designed for, and adapted with input from, lung transplant recipients could possibly improve long-term adherence and enable personalized treatment for individual patients [ 14 ].…”

From Nonadherence to Adherence

“…[49][50][51][52] Recent studies in kidney and lung transplantation have accomplished variable success rates. [53][54][55] It is important to evaluate these novel technological applications not on a level of hardware performance (which is an implicated prerequisite), but firstly on their value for improving: medication adherence and adherence in general, a healthy life style and support of patients to achieve better self-management and self-care agency. Secondly, taking into account the costs and resources associated with these technologies, convincing and relevant improvements in…”