Inter-Dose Variability of Immunosuppressant Medication Among Adolescent Heart Transplants During Video Directly Observed Therapy

Abstract

Background: Medication adherence and timing of doses remains a challenge for adolescent patients following heart transplant. Mobile technology and adherence promotion efforts offer new avenues for direct observation of medication adherence and timeliness of medication-taking behavior. The study explores posttransplant medication maintenance, highlighting the importance of consistent dose timing with tacrolimus. The use of directly observed therapy (DOT) via a mobile health app was examined as a method for real-time medication monitoring, offered a platform for patients to upload videos of themselves taking medication for review by transplant team members. Methods: The study examined a single-group design involving 10 adolescent heart transplant recipients over a 12-week DOT intervention, assessing both medication adherence and post-intervention outcomes. Results: Results from multilevel regression models analyzing inter-dose timing and deviation from 12-h intervals revealed significant variability among patients and a correlation between increased deviation from the 12-h dose interval and both older patients and those with greater perceived barriers to medication adherence. Conclusions: Findings suggested a link between deviation from recommended dose timing and poorer posttransplant health outcomes. Findings underscored the potential of DOT and mobile health to examine timeliness of medication adherence, to directly observe medication-taking behavior, and association with posttransplant health outcomes.