title: Conventional vs. tablet computer-based patient education following lung transplantation--a randomized controlled trial.
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.
  
  
  METHODS
  Single-centre, open labelled randomised controlled trial.
  
  
  METHODS
  Patients >6 months after lung-transplantation with <50% of calcineurin inhibitor trough levels in target range.
  
  
  METHODS
  Tablet-pc education versus personal, nurse-led education.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Education is a simple, effective tool in improving adherence to immunosuppression. Tablet-PC education was non-inferior to conventional education.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01398488 http://clinicaltrials.gov/ct2/show/NCT01398488? term=gottlieb+tablet+pc+education&rank=1.
authors.affiliation: Dept. of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Suhling
authors.affiliation: Dept. of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Jessica
authors.initials: J
authors.lastname: Rademacher
authors.affiliation: Dept. of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Imke
authors.initials: I
authors.lastname: Zinowsky
authors.affiliation: Dept. of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Fuge
authors.affiliation: Dept. of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Greer
authors.affiliation: Dept. of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Gregor
authors.initials: G
authors.lastname: Warnecke
authors.affiliation: Eurotransplant International Foundation, Leiden, The Netherlands.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Smits
authors.affiliation: Dept. of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Bertram
authors.affiliation: Dept. of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Dept. of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.affiliation: Dept. of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Gottlieb
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D034201:Computers, Handheld / Q000191:economics*; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016040:Lung Transplantation; D008875:Middle Aged; D010353:Patient Education as Topic / Q000191:economics / Q000379:methods*
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents