AB077. Initial study of smartphone-based intervention to improve the medical adherence in living donor renal transplant recipients

Objective: Renal transplantation is considered to be the preferred treatment comparing with dialysis. However, the inherent risk of renal transplantation brings lifelong regimen of immunosuppressive medication and active surveillance. It is known that poor compliance can increase 60% risk of graft failure. Intervention targeting behavioral risk factors or a combination of behavioral, educational and emotional changes has positive effect in medication adherence. These interventions need to be utilized by a well-established and organized healthcare system. In China, most of living donor renal transplantation recipients are from rural area which is still facing healthcare shortages. We found some of post-transplanted patients were using smartphone apps to manage their medication to avoid medication missing. The present retrospective study is to discuss the feasibility of smartphone app on medical compliance intervention in living donor renal transplantation patients in China.

Methods: A total of 100 living donor recipients who were followed up in our hospital regularly were involved in this study. For the first step, we designed a questionnaire to survey demographic data and whether they were using smartphone app to manage their medications. Then we compared the medical adherence between the patients using and not using smartphone apps. Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) was applied to evaluate the medical adherence. We also investigated the willing of using smartphone apps to manage the medication in living donor renal transplanted recipients. Descriptive statistics were calculated to describe survey item response.

Results: A total of 94% of recruited patients (94 of 100) participated. Twenty-three cases (Group A, 24.5%) were using smartphone apps to manage their medication and the rest 71 cases were not (Group B, 75.5%). When comparing group A and B, it showed the younger and well educated patients had more willing to use smartphone apps to remind their medication. In China, living area is a good marker to reflect the patients’ socioeconomic factors which were considered to be one of major influencing factors of medical adherence. Thus, according to regional differences, 1:1 stratified sampling was performed to randomly select 23 cases in group B as group C. Comparing with group C, Group A showed better medical adherence (P=0.049), but no difference in age, education level, renal function and immunosuppressive regimen. It showed smartphone app could enhance immunosuppressive medication adherence. In willingness investigation, most recipients owned smartphone (91.5%), 71.8% patients has strong demand for medication management equipment while more than half patients reported they would be willing to manage their medication via smartphone apps.

Conclusions: our study demonstrated the smartphone-based medication management may be able to be an effective intervention to improve the living donor renal transplantation patients’ compliance. Most recipients were willing to adopt smartphone-based post-operative medication reminder. Further studies will focus on smartphone app design and discuss whether smartphone based medical adherence intervention could improve the long-term outcomes of renal transplantation.

Keywords: Medical adherence; living donor renal transplant; smartphone