Abstract
BackgroundAccurate immunosuppression is of critical importance in preventing rejection, while avoiding toxicity following lung transplantation. The mainstay immunosuppressants are calcineurin inhibitors, which require regular monitoring due to interactions with other medications and diet. Adherence to immunosuppression and patient knowledge is vital and can be improved through patient education. Education using tablet-computers was investigated.ObjectiveTo compare tablet-PC education and conventional education in improving immunosuppression trough levels in target range 6 months after a single education. Secondary parameters were ratio of immunosuppression level measurements divided by per protocol recommended measurements, time and patient satisfaction regarding education.DesignSingle-centre, open labelled randomised controlled trial.ParticipantsPatients >6 months after lung-transplantation with <50% of calcineurin inhibitor trough levels in target range.InterventionTablet-pc education versus personal, nurse-led education.MeasurementsCalcineurin inhibitor levels in target range 6 months after education, level variability, interval adherence, knowledge and adherence was studied. As outcome parameter, renal function was measured and adverse events registered.ResultsSixty-four patients were 1:1 randomised for either intervention. Levels of immunosuppression 6 months after education were equal (tablet-PC 58% vs. conventional 48%, p = 0.27), both groups improved in achieving a CNI trough level within target range by either education method (delta tablet-PC 29% vs. conventional 20%). In all patients, level variability decreased (−20.4%), whereas interval adherence remained unchanged. Knowledge about immunosuppression improved by 7% and compliance tests demonstrated universal improvements with no significant difference between groups.ConclusionEducation is a simple, effective tool in improving adherence to immunosuppression. Tablet-PC education was non-inferior to conventional education.Trial RegistrationClinicalTrials.gov NCT01398488 http://clinicaltrials.gov/ct2/show/NCT01398488?term=gottlieb+tablet+pc+education&rank=1.
Highlights
It has been previously demonstrated in a variety of chronic diseases that non-adherence to medication and other forms of treatment is a major problem [1], which may impact on long-term outcomes [2,3]
Levels of immunosuppression 6 months after education were equal, both groups improved in achieving a calcineurin inhibitors (CNI) trough level within target range by either education method
Patient education and awareness is considered pivotal in improving adherence, with various concepts having already been developed to address this [5,6]
Summary
It has been previously demonstrated in a variety of chronic diseases that non-adherence to medication and other forms of treatment is a major problem [1], which may impact on long-term outcomes [2,3]. Patients require highly complex treatment regimes based on various immunosuppressant drugs that have small therapeutic ranges and profound side-effect profiles [11]. Sub-therapeutic immunosuppression remains a leading cause of allograft rejection, graft loss, and death [12]. It is associated with decreased quality of life and inevitably increased health care costs. Previous studies have demonstrated non-adherence rates in calcineurin inhibitors (CNI) ranging between 13 and 22% [13].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
