Conventional vs. tablet computer-based patient education following lung transplantation--a randomized controlled trial

Hendrik Suhling, Jessica Rademacher, Imke Zinowsky, Jan Fuge, Mark Greer, Gregor Warnecke, Jacqueline M Smits, Anna Bertram, Axel Haverich, Tobias Welte, Jens Gottlieb, Hendrik Suhling, Jessica Rademacher, Imke Zinowsky, Jan Fuge, Mark Greer, Gregor Warnecke, Jacqueline M Smits, Anna Bertram, Axel Haverich, Tobias Welte, Jens Gottlieb

Abstract

Background: 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.

Objective: 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.

Design: Single-centre, open labelled randomised controlled trial.

Participants: Patients >6 months after lung-transplantation with <50% of calcineurin inhibitor trough levels in target range.

Intervention: Tablet-pc education versus personal, nurse-led education.

Measurements: 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.

Results: 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.

Conclusion: Education is a simple, effective tool in improving adherence to immunosuppression. Tablet-PC education was non-inferior to conventional education.

Trial registration: ClinicalTrials.gov NCT01398488 https://ichgcp.net/clinical-trials-registry/NCT01398488? term=gottlieb+tablet+pc+education&rank=1.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow chart of inclusion and…
Figure 1. Flow chart of inclusion and improvement of immunosuppression.
Flow chart of inclusion (A). Delta % of calcineurin inhibitor trough levels in target range 6 months after patient education compared to 6 months before patient education (B). Dashed line marks cut-off of non-inferiority (lower 95% CI of conventional group, p = 0.17). Visualization of calcineurin inhibitor levels at inclusion (x-axis) and after 6 months (y-axis) (C).

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