Development and Evaluation of a Mobile Directly Observed Therapy Smartphone App for Immunosuppressive Adherence in Transplant Patients

项目摘要 实体器官移植(SOT)后的结果通常很好，5年存活率超过 大多数移植物类型和年龄组为85%。免疫抑制不粘连是导致 SOT受者的移植物衰竭和患者死亡率，因为个人需要一生 承诺严格的用药时间表。据报道，不遵守的比例在15%到40%之间 在肝病患者中超过30%，在肾病患者中超过30%。 移动应用程序(“app”)提供了一个低成本且可扩展的机会来提高服药依从性 通过更一致的监控、更早地发现违规行为和频繁的患者提供者 与不依从者的沟通。我们已经开发了一个面向患者的mHealth应用程序，MDOT for 移植，使患者能够查看他们的免疫抑制方案，记录自己服用 他们的药物剂量，跟踪和可视化他们自己和他们的移植协调员的进展， 记录症状和副作用，并获取教育内容。有一家器官移植供应商网络- 基于平台，他们可以在该平台上审查患者提交的视频，并提供接受视频的反馈 依从性的证据，并在患者报告症状时收到通知。 拟议的项目旨在优化这一工具，以提高移植受者的用药依从性。这个 该项目的目标是：1)通过双向患者提供者提高移植的MDOT 通信/消息传递功能和标准化文本消息，以促进行为改变和2) 在SOT中进行MDOT移植与标准护理的先导性随机对照试验 病人。

Project Summary Outcomes following solid organ transplantation (SOT) are generally excellent with 5-year survival exceeding 85% for most graft types and age groups. Immunosuppression nonadherence is an important factor leading to graft failure and patient mortality in SOT recipients since individuals are required to make a lifelong commitment to a strict medication schedule. Nonadherence has been reported to range from 15 to 40% among liver patients and more than 30% among kidney patients. Mobile applications (“apps”) provide a low-cost and scalable opportunity to improve medication adherence through more consistent monitoring, earlier detection of nonadherence, and frequent patient-provider communication with nonadherent patients. We have developed a patient-facing mHealth app, mDOT for Transplantation, that enables patients to view their immunosuppression regimen, record themselves taking doses of their medication, track and visualize progress on their own and with their transplant coordinator, document symptoms and side effects, and access educational content. There is a transplant provider web- based platform where they can review patient submitted videos, provide feedback about accepting the video as evidence of adherence, and receive notifications when patients report symptoms. The proposed project seeks to optimize this tool to increase medication adherence in transplant recipients. The aims of the project are: 1) to enhance mDOT for Transplantation with 2-way patient-provider communication/messaging capabilities and standardized text messages to promote behavior change and 2) to perform a pilot randomized controlled trial of mDOT for Transplantation compared to standard-of-care in SOT patients.