title: Randomized Controlled Trial of a Computer-Based Education Program in the Home for Solid Organ Transplant Recipients: Impact on Medication Knowledge, Satisfaction, and Adherence.
abstract: De novo solid organ transplant recipients (SOTR) have a steep learning curve to acquire medication knowledge. Without adequate knowledge, SOTR are at risk of nonadherence and poor transplant outcomes.
  
  
  
  In this nonblinded, randomized controlled trial, de novo SOTR received standard teaching with or without postdischarge computer-based education (CBE) at home. Primary outcomes were change in knowledge (quiz and recall) and satisfaction, assessed by questionnaires at baseline and 3 months. Adherence was evaluated via self-report and immunosuppressant levels.
  
  
  
  Two hundred forty-six patients were randomized and 209 completed the 3-month analysis. In the intervention arm, 73 (57.9%) used the CBE program. Change in knowledge quiz score did not differ between groups (4.9% vs 0.6%; P = 0.084), despite a significant increase within the intervention (72.4% vs 77.3%, P = 0.007) but not the control (76.0% vs 76.6%, P = 0.726) arms. Both groups had a significant improvement in recall (intervention, 56.7% vs 82.1%, P < 0.001; control, 51.3% vs 79.7%, P < 0.001), with similar changes in scores (25.4% vs 28.4%, P = 0.55). Change in satisfaction differed between groups (intervention, 1.2% vs control, -4.9%; P = 0.050). There was a significant decline in satisfaction within the control group (88.4% vs 83.5%, P = 0.035), whereas satisfaction was maintained with the intervention (85.6% vs 86.8%, P = 0.55). Adherence was similar in both groups.
  
  
  
  Knowledge improved over the study period in both groups, with no incremental benefit for the intervention. Patient satisfaction was maintained with the CBE program. More research is needed to identify barriers to uptake of CBE at home and to develop effective strategies for posttransplant education.
authors.affiliation: 1 Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada. 2 Department of Pharmacy Services, Toronto General Hospital, University Health Network, Toronto, ON, Canada. 3 Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. 4 Division of Nephrology, Toronto General Hospital and St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. 5 Institute of Health Policy, Management, and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Harrison
authors.forename: Souzi
authors.initials: S
authors.lastname: Badr
authors.forename: Bassem
authors.initials: B
authors.lastname: Hamandi
authors.forename: Sang Joseph
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D003194:Computer-Assisted Instruction; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009864:Ontario; D016377:Organ Transplantation / Q000009:adverse effects; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D011446:Prospective Studies; D012648:Self Care; D011795:Surveys and Questionnaires; D013997:Time Factors; D066027:Transplant Recipients / Q000523:psychology*; D016896:Treatment Outcome