A Mobile App (mHeart) to Detect Medication Nonadherence in the Heart Transplant Population : Validation Study
Gomis-Pastor, Mar (Institut d'Investigació Biomèdica Sant Pau)
Roig, Eulàlia (Universitat Autònoma de Barcelona. Departament de Medicina)
Mirabet Pérez, Sonia (Institut d'Investigació Biomèdica Sant Pau)
De Pourcq, Jan T.. (Institut d'Investigació Biomèdica Sant Pau)
Conejo, Irene (Institut d'Investigació Biomèdica Sant Pau)
Feliu, Anna (Institut d'Investigació Biomèdica Sant Pau)
Brossa Loidi, Vicens (Institut d'Investigació Biomèdica Sant Pau)
López-López, Laura (Institut d'Investigació Biomèdica Sant Pau)
Ferrero-Gregori, Andreu (Institut d'Investigació Biomèdica Sant Pau)
Barata, Anna (Moffitt Cancer Center)
Mangues, Ma Antonia (Institut d'Investigació Biomèdica Sant Pau)

Date:	2020
Abstract:	Medication nonadherence in heart transplant recipients (HTxR) is related to graft loss and death. mHeart is a mobile app that uses electronic patient-reported outcome measures (ePROMs) to identify and manage medication nonadherence in the outpatient heart transplant (HTx) population. The study primarily aimed to validate mHeart to measure medication nonadherence in early stage HTxR by assessing the psychometric properties of ePROMs. The secondary aims were to (1) measure patient satisfaction with the mHeart tool and its usability and (2) explore the impact of a theory-based treatment on medication nonadherence rates to determine its scalability to larger research. A prospective study was conducted in the outpatient clinic of a tertiary hospital. All consecutive early stage HTxR (<1. 5 years from HTx) were included. The ePROM psychometric properties assessed were validity, reliability, responsiveness, interpretability, and burden. ePROMs comprised the 4-item Morisky-Green-Levine questionnaire and an adapted version of the Haynes-Sackett questionnaire. The Simplified Medication Adherence Questionnaire (SMAQ) was also applied on-site. Three consecutive medication nonadherence assessments were performed by a transplant pharmacist. To improve medication nonadherence, theory-based interventions were delivered in a 1-month period. Patient satisfaction was assessed by a semiquantitative Web-based survey at the end of the study. We included 31 early stage HTxR (age: mean 54 years, SD 12 years), and 71% (22/31) of them were men. The HTxR were taking a mean 13 (SD 4; range 7-18) drugs per day. A total of 42% (13/31) of patients were unaware of the consequences of medication nonadherence, and 39% (12/31) of patients were nonadherent to immunosuppressive treatment. The content validity measure showed excellent levels of expert panel agreement for the Haynes-Sacket (14/14, 100%) and Morisky-Green-Levine (13/14, 93%) questionnaires. SMAQ and Morisky-Green-Levine ePROMs showed similar measurement domains (convergent validity, phi=0. 6, P <. 001), which, as expected, differed from Haynes-Sackett ePROMs (divergent validity, phi=0. 3, P =. 12). Reliability assessment revealed a very strong association between ePROM and on-site PROMs (phi>0. 7, P <. 001). Reproducibility was moderate (Haynes-Sackett κ=0. 6, P <. 002) or poor (Morisky-Green-Levine κ=0. 3, P =. 11) because of unexpected improved medication adherence rates during the test-retest period. According to responsiveness, the theory-based multifaceted intervention program improved medication nonadherence by 16% to 26% (P <. 05). A burden analysis showed that ePROMs could potentially overcome traditional on-site limitations (eg, automatic recording of ePROM responses in the hospital information system). The mean score for overall patient satisfaction with the mHeart approach was 9 (SD 2; score range: 0-10). All 100% (29/29) of patients surveyed reported that they would recommend the mHeart platform to other HTxR. ePROMs adhered to the quality standards and successfully identified medication nonadherence in the HTx population, supporting their widespread use. The theory-based intervention program showed a promising improvement in medication adherence rates and produced excellent patient satisfaction and usability scores in HTxR.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Self-report ; Patient-reported outcome measures ; Behavioral sciences ; Treatment adherence and compliance ; Transplantation ; Early medical intervention ; Telemedicine ; Mobile health ; Validation studies ; Patient satisfaction
Published in:	JMIR mHealth and uHealth, Vol. 8 (february 2020) , ISSN 2291-5222

DOI: 10.2196/15957
PMID: 32014839

19 p, 1.0 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
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