Conventional vs. Tablet Computer-Based Patient Education following Lung Transplantation – A Randomized Controlled Trial

<div><p>Background</p><p>Accurate 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.</p><p>Objective</p><p>To 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.</p><p>Design</p><p>Single-centre, open labelled randomised controlled trial.</p><p>Participants</p><p>Patients >6 months after lung-transplantation with <50% of calcineurin inhibitor trough levels in target range.</p><p>Intervention</p><p>Tablet-pc education versus personal, nurse-led education.</p><p>Measurements</p><p>Calcineurin 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.</p><p>Results</p><p>Sixty-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.</p><p>Conclusion</p><p>Education is a simple, effective tool in improving adherence to immunosuppression. Tablet-PC education was non-inferior to conventional education.</p><p>Trial Registration</p><p>ClinicalTrials.gov NCT01398488 <a href="http://clinicaltrials.gov/ct2/show/NCT01398488?term=gottlieb+tablet+pc+education&rank=1" target="_blank">http://clinicaltrials.gov/ct2/show/NCT01398488?term=gottlieb+tablet+pc+education&rank=1</a>.</p></div

Demographics.

<p>Patient demographics and characteristics. Categorical variables were compared using a chi-square test and numeric values were shown as median with IQR, using student's t-test.</p

End point results.

<p>*<1: less measurements than required, >1 more measurements than required.</p><p>Results from pre-defined end-points. All values are shown as median with IQR (student's t-test).</p

Adherence Scores.

<p>Results from subjective and objective adherence (BAASIS, VAS, ITBS and Morinsky scale). ^a Self reported adherence: 1–4 points; 1 poor adherence, 4 very good adherence. ^b VAS (visual analogue scale of BAASIS questionnaire) 0 to 100; 100 very good self rated adherence.</p>c<p>Mann-Whitney-U-Test, Mean (SD); ^d Satisfaction, 1–5 points (1 very good to 5 very bad); Mean (SD), Mann-Whitney-U-Test.</p

End points.

<p>End points.</p