INTRODUCTION AND AIMS: Non-adherence to medication is one of the leading problems causing poor long-term outcome in kidney transplant recipients (KTR). Here we analyze the impact of post-transplant use of a medication reminder app.
METHODS: We initiated a prospective randomized controlled trial in our outpatient clinic in August 2016. Smartphone use, knowledge about own medication, interest in adherence assistance by app use and recent adherence measured by 8-item Morisky Medication Adherence Scale (MMAS-8) were assessed. In the follow-up period attrition rate of app use and different outcomes in the groups were analyzed. The study was approved by local data safety board and ethics committee.
RESULTS: Overall 340 KTR were screened for study inclusion. 191 (56%) KTR had a smartphone, 159 (83%) of those were interested to use an app. 11 KTR could not use the app due to missing technical requisites. In total 148 KTRs were 1:1 randomized to the app or the control group. Medium age was 46 (12), medium time after kidney transplantation 5.2 years (3.0-9.8). Medium number of prescribed medications was 8.2 (3.2), prescribed pills per day 11.8 (4.7). Percentage of prescribed medications remembered exactly (name, dosage, schedule) was 39%, 74% of medication were only remembered approximately. 34% of KTR admitted sometimes to forget to take their medication. 34% of KTR had +10 different prescribed medications (median 12 drugs, 17 pills per day) of which only 2 (median) could be remembered exactly (Fig.1). Overall MMAS-8 was 6.8 (1.2), indicating only medium adherence levels. Relationship between MMAS-8, number of prescribed medications, years after transplantation and age confirmed in a multiple regression analysis the independent correlation of younger age and shorter time after transplantation with worse adherence levels (rho of 0.18, p=0.034 and rho 0.21, p=0.012, respectively). Of note, in our cohort smartphone penetration was very high among younger KTR (92% in KTR <50 years (Fig. 1b). However, attrition rate in app use at months 12 (displayed for n=88 KTR) was 54% (Fig. 1c).
CONCLUSIONS: KTR with high pill burden have deficits about the knowledge of their own medication. We suggest that medication reminder apps might support adherence particularly in younger KTR short-term after transplantation.
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