1. http://sctr.musc.edu 843-792-8300 Mobile Technology and Medication Adherence in Renal Transplantation Subtitle Presenters Date John W McGillicuddy, MD Martina Mueller, PhD Gayenell S Magwood, PhD, RN Signe Denmark, MS Ronja Frenzel, BS Ana Weiland, BS Frank A Treiber, PhD Sachin Patel, MSc Brenda Brunner-Jackson, MPH

2. http://sctr.musc.edu 843-792-8300 Rationale ESRD afflicts more than 500,000 people in the USA at cost of more than $29,000,000,000/year Kidney transplantation offers better quality of life and longer life expectancy than chronic dialysis at a significantly lower cost Despite significant advances, average graft survival is suboptimal at only 9 years Kidneys are an incredibly scarce resource which mandates that their use be optimized Graft survival is worse among African-Americans and those of lower socioeconomic status

3. http://sctr.musc.edu 843-792-8300 Rationale Medication nonadherence is key contributor to premature graft loss Approximately 35% of renal transplant patients are nonadherent Nonadherence contributes to graft loss by allowing for immune mediated rejection and the deleterious effects of poorly controlled comorbid conditions (i.e., HTN) Mobile health (mHealth) technology has the potential to positively impact medication adherence and thereby improve graft survival

4. http://sctr.musc.edu 843-792-8300 Acceptability Little is known about renal transplant patients’ attitudes toward mHealth technology To determine our patients’ attitudes toward mHealth and their willingness and ability to use the technology, a survey of kidney transplant recipients was undertaken 105 patients were surveyed in our kidney transplant clinic after being given a demonstration of a prototype mHealth system

5. http://sctr.musc.edu 843-792-8300 SURVEY: Demographics Mean age: 52 yearsMale sex: 64% Ethnicity: 62% AA1st transplant: 89% Income: 60%* @ <$30,000 Travel time: 75% travel >1h

6. http://sctr.musc.edu 843-792-8300 SURVEY: Results Adherence is a real problem for our patients 74% reported at least some difficulty with medication adherence based on a 7-item Modified Morisky Scale Use of health aides at home is high 85% were using home BP cuff/monitor 63% were using medication dispensing device Mobile phones technology is nearly ubiquitous 90% have mobile phones 52% have “smart” mobile phones

7. http://sctr.musc.edu 843-792-8300 SURVEY: Results A mere 7% had any prior knowledge of mHealth technology Only 6% were uncomfortable with being monitored using mHealth technology 23% were concerned about the adequacy of privacy protection

8. http://sctr.musc.edu 843-792-8300 SURVEY: Results 82% felt that mHealth technology would help them better follow their MD’s directions 85% felt that the technology would enable their MDs to make changes more quickly 87% agreed that mHealth technology would improve communication between MD and patient ✔ Provided free use, 80% responded that they would use the system

9. Pilot RCT Utilize wireless technology to identify nonadherent patients and interact with them in real time: http://sctr.musc.edu 843-792-8300  

10. http://sctr.musc.edu 843-792-8300 Study Design and Methods Type: Pilot RCT Subjects: 20 nonadherent kidney transplant patients Methods: Group A: standard post operative care Group B: mHealth program: wireless real time medication reminders, blood pressure monitoring, cognitive behavior adherence skills program

11. http://sctr.musc.edu 843-792-8300 Study Design and Methods Technology Maya to monitor and aid in medication adherence Bluetooth enabled Fora D15b to measure and record BP “Smart” phones for signal transmission “Smart” phones for patient interaction Cognitive behavioral enhancement techniques via video conferencing with adherence coach

12. http://sctr.musc.edu 843-792-8300 Outcome Measures

13. http://sctr.musc.edu 843-792-8300 Study Design and Methods

14. http://sctr.musc.edu 843-792-8300 Where Are We?

15. http://sctr.musc.edu 843-792-8300 Questions?