UF Health Clinical Researchers Part of Pilot Study to Help Improve Outcomes in Pediatric Transplant Patients
A pilot study conducted by clinical researchers from University of Florida and Florida State University assessed the feasibility, acceptability and efficacy of using video-enabled directly observed therapy, or DOT, to help adolescent heart transplant patients track and improve adherence.
Published in the journal Pediatric Transplantation, the study suggests video DOT can help adolescent heart transplant recipients better stay on their medications, avoid hospitalizations and reduce the potential of rejection. Video DOT scales a model of care for medication adherence support with the use of mobile devices.
The program was developed by a company called emocha Health, a digital health company based in Baltimore that seeks to improve medication adherence through video technology and engagement. The app allows patients to securely self-record videos while taking their medication, report any side effects and communicate with their remote care teams. Transplant center clinicians and emocha care team staff review the videos and communicate back to patients via the app to engage and encourage medication adherence.
“To improve long-term survival post-transplant, we need to put a greater focus on supporting patients in adhering to lifesaving treatments. Non-adherence with immunosuppressant medications is a huge challenge for adolescent transplant patients,” said pediatric transplant cardiologist and co-author Dr. Dipankar Gupta of the University of Florida’s Congenital Heart Center.
In the 12-week pilot study, 14 adolescent heart transplant recipients (ages 11-21) were invited to use , enhanced with daily clinical support to encourage medication adherence. The researchers particularly sought to engage patients with a history of poor adherence. Those who completed the program had a 90.1% adherence rate, submitting 1,211 videos out of 1,344 expected. By contrast, five of the six patients (83.3%) who did not begin video DOT or dropped out were hospitalized or experienced episodes of acute organ rejection. In addition to video messages, more than 800 chat messages were exchanged between patients and their care teams. The study also found high patient and parent satisfaction with the technology, support provided and their experience in the program.
It is vital that transplant recipients take their medications consistently, sometimes twice per day at the same time, to avoid graft failure. Yet often adolescents don’t follow their medication regimens carefully, for many reasons. Pediatric transplant recipients have a non-adherence rates as high as 40% to 60% during their teenage years, leading to a greater number of organ rejections and hospitalizations. The consequences of organ rejection can be fatal and non-adherence can impact the candidacy to receive a new donor organ.
“Adolescents are at a vulnerable time in their development and often struggle to stick with transplant medications,” said the study’s lead investigator and co-author, Michael Killian, Ph.D., M.S.W, an assistant professor at the Florida State University College of Social Work. “Improving adolescents’ medication adherence, especially through the use of the mobile digital technologies that are already so widely used by patients and their families, is a promising avenue to better health outcomes.”
The technology has also been successfully validated to improve adherence to medications in the treatment of other chronic and infectious diseases such as asthma, tuberculosis, diabetes and hepatitis C.