Oral Papers: Addiction, Pain, & Transplant I
Background/Significance: Mobile health (mHealth) technologies offer promising solutions for minimizing nonadherence after organ transplantation (Fleming, 2017). Nonadherence is prevalent in lung transplant recipients (LTRs), with rates up to 70% for some elements of the multicomponent regimen by 2-3 years posttransplant (Hu, 2017). We designed Pocket Personal Assistant for Tracking Health (Pocket PATH), a smartphone application (app), to enhance adherence to the post-lung transplant regimen. It is the only app in transplantation tested in a full-scale randomized controlled trial (DeVito Dabbs, 2016): LTRs using Pocket PATH showed better adherence than LTRs receiving usual care during the first year posttransplant. Herein, we examine whether its effects were maintained beyond the trial’s end, and evaluate potential risk factors for long-term nonadherence.
Methods: Adherence in eight areas was evaluated at follow-up in separate LTR and family caregiver (collateral) assessments. Potential nonadherence risk factors were obtained (a) at transplant (transplant-related characteristics; sociodemographics; psychosocial characteristics such as social support), (b) during the first year posttransplant, i.e., the original trial period (nonadherence levels, psychiatric symptomatology, medical complications), or (c) at follow-up (psychiatric symptomatology). Pocket PATH and usual care groups’ nonadherence rates were compared; multivariable regression analyses then compared the groups’ nonadherence controlling for the other patient characteristics, and examined whether each such characteristic increased nonadherence risk.
Results: 105 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/lifestyle requirements (spirometry, blood pressure monitoring, diet, exercise), 13%-23% for immunosuppressants and other medications, and 4% for tobacco use; and 31% for clinic appointment attendance in the past year. In multivariable analysis, the Pocket PATH group showed less nonadherence to lifestyle requirements (diet/exercise) than the usual care group (p< .05). Overall, younger age; nonadherence and transplant-related complications during the first year posttransplant (acute graft rejection, less time rehospitalized); and chronically elevated anxiety during that first year each increased nonadherence risk in at least one area at follow-up (Odds Ratios, 1.04 to 3.11, p’s< .05).
Conclusions: Pocket PATH did not have sustained impact on most areas of the regimen, although we identified other factors predicting long-term nonadherence. Of note, chronic anxiety increased nonadherence risk, consistent with anxiety’s deleterious in other lung disease populations. Future work should explore strategies to facilitate sustained effects of mHealth interventions and reduce the impact of nonadherence risk factors.
DeVito Dabbs A, Song MK, Myers BA, et al. A randomized controlled trial of a mobile health intervention to promote self-management after lung transplantation. Am J Transplant 2016;16(7):2172-80.
Fleming JN, Taber DJ, McElligott J, et al. Mobile health in solid organ transplant. Am J Transplant 2017;17(9):2263-76.
Hu L, Lingler JH, Sereika SM, et al. Nonadherence to the medical regimen after lung transplantation:A systematic review. Heart Lung 2017;46(3):178-86.