Triplett Kelli N, El-Behadli Ana F, Masood Saba S, Sullivan Sarah, Desai Dev M
Solid Organ Transplant Department, Children's Health - Children's Medical Center, Dallas, Texas.
University of Texas Southwestern Medical Center, Dallas, Texas.
Pediatr Transplant. 2019 Nov;23(7):e13555. doi: 10.1111/petr.13555. Epub 2019 Jul 22.
Given the complexity of the pediatric post-transplant medication regimen and known medication adherence difficulties within the solid organ transplant population, interventions to improve adherence continue to be explored and fine-tuned. Advances in technology have led to the development of new programs aimed at improving medication adherence and the overall care of transplant patients. This manuscript describes implementation of a DMP where transplant patients' medications were co-encapsulated with ingestible sensors, and adherence was monitored via a patient mobile application and a provider portal. The benefits and challenges of the DMP as reported by patients, caregivers, and medical providers are explored in this manuscript. Participant feedback regarding best practices highlighted these benefits: ease of use/intuitive technology, sense of improved communication with medical team, increased knowledge and motivation around treatment regimen, and positive self-reports of medication adherence. Challenges included reluctance to participate (n = 43, 54.43% of patients approached declined participation) and patch wearability difficulties reported by participants (n = 20; 68.97%). Other notable challenges included the following: limited drug profile compatibility with the DMP technology and concerns about privacy and electronic data sharing for patients who chose not to participate. DMP implementation highlighted how technological advances offer novel methods to assess adherence, enhance medical decision-making, and can potentially improve clinical outcomes. Although numerous benefits of the program were recognized by participants, challenges were identified and the DMP technology and medication panel continues to be refined; further investigation of such programs continues to be warranted.
鉴于儿科移植后药物治疗方案的复杂性以及实体器官移植人群中已知的药物依从性困难，改善依从性的干预措施仍在不断探索和优化。技术的进步促使了旨在提高药物依从性和移植患者整体护理水平的新项目的开发。本文描述了一种药物管理程序（DMP）的实施情况，即移植患者的药物与可摄入传感器共同封装，并通过患者移动应用程序和医疗服务提供者门户监测依从性。本文探讨了患者、护理人员和医疗服务提供者报告的DMP的益处和挑战。参与者关于最佳实践的反馈突出了这些益处：易用性/直观的技术、与医疗团队沟通改善的感觉、对治疗方案的了解和积极性增加，以及药物依从性的积极自我报告。挑战包括不愿参与（n = 43，被邀请的患者中有54.43%拒绝参与）以及参与者报告的贴片佩戴困难（n = 20；68.97%）。其他值得注意的挑战包括：与DMP技术的药物配置文件兼容性有限，以及对于未选择参与的患者的隐私和电子数据共享的担忧。DMP的实施突出了技术进步如何提供评估依从性、增强医疗决策并可能改善临床结果的新方法。尽管参与者认可该项目的诸多益处，但也发现了挑战，DMP技术和药物配置仍在不断完善；对此类项目的进一步研究仍有必要。
