Developing Mobile Health Tools for Long-term Medication Adherence in Transplant Patients?

Patient-reported usability challenges when implementing integrated EHR medication reminders for kidney transplant patients in a home setting: A pilot study

BACKGROUND

With an aging population and the increasing prevalence of chronic diseases such as chronic kidney disease (CKD), kidney transplantation is the preferred treatment for end-stage renal disease due to its superior clinical outcomes and cost-effectiveness compared to dialysis. Although EHR-integrated medication reminders have the potential to enhance adherence in transplant patients, their feasibility require further investigation.

OBJECTIVE

The objective of this pilot study was to assess the feasibility of an integrated medication reminder tool for kidney transplant patients in terms of experienced usability and satisfaction.

METHODS

A single-arm survey design was used to assess the usability and satisfaction in kidney transplant recipients using an EHR-integrated medication reminder tool through the patient portal at a large academic hospital in the Netherlands. Usability and satisfaction were evaluated using the validated Experienced Usability and Satisfaction with self-monitoring in the home Setting (GEMS) questionnaire comprising four subconstructs: Convenience of use, Perceived value, Efficiency of use, and Satisfaction. Quantitative data were analysed and assessed through descriptive statistics. Furthermore, six additional questions assessed logging into the system, ease of follow-up on reminder, satisfaction with reminder timing, perceived support for adherence, occurrence of incorrect reminders, and willingness to continue using the tool, using Likert scales and open-ended responses.

RESULTS

In total, forty-three patients participated in this study. The results showed mixed experienced usability and satisfaction, with a GEMS score of 65.0%. The Efficiency of use subconstruct revealed issues such as difficulties in checking off medication and accessing the patient portal. The Satisfaction subconstruct revealed limitations of the tool, as reminders cannot be customized, creating inconvenience for patients who had developed their own medication routines after transplantation. One third (35.7%) of the patients reported willingness to continue using the tool after the pilot program.

CONCLUSION

The experienced usability and satisfaction of an integrated EHR medication reminder tool were adequate for half of the patients. To facilitate large-scale implementation, improvements of the tool are needed to maximize its effectiveness for kidney transplant patients, particularly by enhancing customization of the notification system to better meet user needs and support medication adherence.

Implementation of a mobile application for outpatient care after liver transplantation

Background

In the face of the Covid-19 pandemic and the need for social distancing new therapeutic tools like mobile health applications might gain in importance for outpatient care. Objective of the present study was to assess if and to what extent the implementation of a free available transplant application in a cohort of liver transplant recipients was possible.

Methods

Patients of the aftercare program at the Department of Transplant Surgery Graz in June 2016 were first asked to complete a survey concerning knowledge about mobile health and their management of everyday life. After using the application for 2 months a second survey evaluated whether the implementation of the application in the daily routine was achievable.

Results

Among 135 patients, 124 (91.9%) agreed to participate. Seventy-one (57.3%) owned a mobile device with which they could use the application, 42 patients (33.8%) decided to try it out for 2 months. The majority stated that the application supported them for therapy management and surveillance of vital parameters. Successful implementation of the application has been reached in 57.1% of patients after 2 months testing period.

Conclusion

The technical prerequisites are only partially met and should be improved. Older patients need extensive support and motivation.

Perceived Susceptibility to Chronic Kidney Disease and Hypertension Self-Management among Black and White Live Kidney Donors

Background

Despite the societal benefits of live kidney donation, Black donors may be more likely than White donors to develop hypertension (HTN) and chronic kidney disease after donation. Among live kidney donors diagnosed with post-donation HTN, little is known about potential racial/ethnic differences in HTN self-care behaviors and perceived susceptibility to developing kidney disease.

Methods

We ascertained electronic medical records and phone survey data from live donors enrolled in the multi-center Wellness and Health Outcomes of LivE Donors (WHOLE-Donor) Hypertension Care Study between May 2013 and April 2020. Using multivariable logistic regression models performed January through June 2021, we examined potential associations of donor race/ethnicity with perceived susceptibility to kidney disease and self-care behaviors (ie, Behavioral Risk Factor Surveillance System measure assessing self-reported actions to control high blood pressure).

Results

The study included 318 US-based live kidney donors who developed post-donation HTN (57.6% female; 78.9% White; 18.6% Black; and mean age 46.7 years at donation). Black donors were equally as likely as White donors to report being moderately or strongly concerned about developing kidney disease (adjusted odds ratio, aOR: 1.27, 95%CI: .66, 2.14, P=.57). Donors with diabetes were more likely than those without diabetes (aOR: 2.43, 95%CI: 1.03, 5.01, P=.04), while donors aged >50 years were less likely than younger donors (aOR: .39, 95%CI: .18, .85, P=.02) to report being moderately or strongly concerned about kidney disease. Overall, 87% of donors reported taking at least one action to help control blood pressure, with no significant differences by sociodemographic factors.

Conclusions

We found no substantial differences in perceived susceptibility to kidney disease among Black and White donors, despite published evidence that Black donors may experience greater risk of developing kidney disease than White donors. Behavioral interventions to enhance knowledge about future disease risk, attitudes, and self-care strategies among living kidney donors may be beneficial.