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Pilot Feasibility Clinical Trial: Telemedicine Infused Adherence

Enhancement for RenalTransplant Patients

SubtitlePresenters

Date

John W McGillicuddy, MDFrank A Treiber, PhD

Martina Mueller, PhDGayenell S Magwood, PhD, RN

Gail Johnson, MSPresented: Verizon Wireless Health Technology Initiative Meeting,

Nov. 15, 2011

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Rationale• ESRD afflicts more than 500,000 people in the USA• HTN and DM are the #1 and #2 causes of ESRD • Kidney transplantation is the treatment of choice for

ESRD• Kidneys are an incredibly scarce resource which

mandates that their use be optimized• Despite significant advances, average graft survival is

suboptimal at approximately 9 years• Graft survival is worse among African-Americans and

those of lower socioeconomic status

http://sctr.musc.edu843-792-8300

Rationale• Medication nonadherence is key contributor to

premature graft loss• Approximately 35% of renal transplant patients are

nonadherent and issues often develop within weeks of transplantation

• Medication nonadherence contributes to graft loss by allowing for immune mediated rejection and the deleterious effects of poorly controlled HTN and DM

• Mobile health technology has the potential to improve medication adherence, blood pressure and blood sugar control, and graft survival

http://sctr.musc.edu843-792-8300

Aim• Utilize wireless technology to identify nonadherent

patients early after transplant and to interact with them in real time to improve adherent behaviors as a means to improve:• Medication adherence• Control of HTN• Control of DM• Graft survival

http://sctr.musc.edu843-792-8300

Study Design and Methods• Type: Randomized control trial• Subjects: 20 nonadherent kidney transplant patients• Methods: randomly assigned to:• Group A: standard post operative care• Group B: “bundled” wireless real time

medication reminder system, blood pressure/blood glucose monitoring, cognitive behavior adherence skills enhancement program

http://sctr.musc.edu843-792-8300

Study Design and Methods• Technology• Maya MedMinder to monitor and aid in

medication adherence• Bluetooth enabled Fora D15b to measure and

record BP and blood glucose• “Smart” phones for signal transmission• “Smart” phones for patient interaction• Cognitive behavioral enhancement techniques

via video conferencing with adherence coach

http://sctr.musc.edu843-792-8300

Study Design and Methods• Outcomes (measured pre-, 1, 2, and 3 months):

• Medication adherence (Maya MedMinder)

• Blood pressure control (Fora D15b, 24h ambulatory BP)

• Blood glucose control (Fora D15b, HgbA1c)

• Immunosuppression (FK506 variability)

Approximately $450.00.Power drain from Bluetooth data transfer.Easy to lose.

Content• Content

TENSION TAMER

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Presented by the COLLEGES of NURSING

and MEDICINE

http://sctr.musc.edu843-792-8300

Study Design and Methods

Alert IndicatorsFlashing LightChimeCell phone call

MedMinder Processing Center

Microsoft HealthVault

Adherence Coach

AND BP Monitor

MedMinderMedication Reminder Device

Android Phone

Healthcare Provider