The Pediatric Heart Transplant Program at NewYork-Presbyterian/Morgan Stanley Children's Hospital is launching a one-year program that will use a text messaging platform to increase medication adherence in its teenage heart transplant patients.
The hospital is working with CareSpeak Communications Inc., a privately held mobile health company in New Jersey, which is providing the two-way technology system that will send the medication alerts to the patients.
Transplant patients are required to follow very strict medication regimens to prevent their bodies from rejecting the “foreign object.” Patients often must take immunosuppressants every day, multiple times per day, for as long as they live. Failing to do so can result in hospitalization, the need for a re-transplant, and even death.
The problem of medication non-adherence is especially challenging with the teen population. According to the journal Pediatric Transplantation non-adherence is the most common cause of organ rejection in long-term transplant patients, and adolescents are in the most high-risk category. Studies have shown that more than half of all teenage liver transplant recipients are non-adherent, and they are four times more likely than adult patients to take their medications at the wrong time or to forget to take them at all.
“Despite extensive educational programs for families and pediatric heart transplant recipients, significant medication noncompliance still occurs with alarming frequency, particularly with adolescents, which can prove deadly,” said Linda Addonizio, the director of the program for Pediatric Cardiomyopathy Heart Failure and Transplantation at NewYork-Presbyterian/Morgan Stanley Children’s Hospital. ”The outlook for long-term survival in non-compliant patients can be as low as 30 percent, compared to 90 percent survival in compliant pediatric heart transplant recipients.”
Caregivers involved in the program will receive a text alert that will say for example, “Joe it’s 8:15am, time to take 1 pill Prograf 1mg. Press REPLY, enter CARE 1 and press SEND”. In the case of older children who have their own cell phone, the text message is sent to them directly. If the patient doesn’t confirm medication intake within a pre-determined amount of time (e.g. 30 minutes), a follow up escalation text alert is sent to as many as two caregivers, alerting them that the patient didn’t report taking their medication. The caregiver message includes the patient’s cell phone number allowing for immediate response.
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Clinicians can access an on-line dashboard at any time to view the patients’ self-reported compliance, frequency of escalation alerts to caregivers, and can also receive weekly e-mail reports.
“At CareSpeak, we believe that a simple and reliable technology such as the CareSpeak system can have a huge public health and economic impact,” said Serge Loncar, CEO of CareSpeak Communications.
CareSpeak Communications continuously upgrades its system design by collaborating with major clinical centers and pharmaceutical companies, in order to include features that will further help increase adherence across all disease verticals such as diabetes, behavioral health, cardiac health, cystic fibrosis, HIV and others.
The efficacy of its system was demonstrated in a study, published in the November 2009 issues of Pediatrics, which found that as a result of receiving regular text alerts through the CareSpeak system, liver transplant patients were more likely to have higher adherence rates. The number of rejections dramatically decreased from 12 episodes the previous year to only two during the study.
The study was conducted by Mt. Sinai Medical Center's Pediatric Gastroenterology Department, under the leadership of Tamir Miloh, MD. Miloh, who is an assitant professor of pediatrics and surgery at the hospital, says the study revealed that regardless of whether the patient remembered to send the reply message confirming that they had taken the medication, after checking for drug levels in the patients’ blood, they found that the level of medication was where they wanted it to be. Half of the patients that participated in the study in 2008 are still in the program today, says Miloh.
“This can be used with every disease where the patients need to take medication on a regular basis,” he added.
Loncar sees the platform as a way for physicians and others to aggregate alot of "meaningful data."
CareSpeak is continuing its work with Mt. Sinai, but this time is working with the hospital on an effort to reduce obesity, says Loncar. The company has also just signed a deal with content provider EverydayHealth, which will provide a solution to the pharmaceutical companies aimed at medication adherence in HIV patients, set to launch in Sept.
