title: Assessment of an Electronic Intervention in Young Women with Heavy Menstrual Bleeding.
abstract: STUDY OBJECTIVE, DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Bleeding disorders (BD) occur in up to 50% of adolescents with heavy menstrual bleeding (HMB). This presents unique challenges to health care providers because of the complexity of treating the condition and such complexity can result in difficulty with patients understanding basic information about their condition, limit communication with medical providers, and patient compliance. The aim of the study was to use an electronic approach to enhance patient compliance with medications used to treat their HMB, and to provide educational access to adolescents with BD. This was a prospective cohort study involving patients in a Young Women's Bleeding Disorder Clinic at a single children's hospital. Subjects were given an iPod Touch (Apple Inc, Cupertino, CA) device (ITD), preloaded with the iPeriod (Winkpass Creations) application. Participants recorded information about their BD that they learned about on BD Web sites, and menses, and medications. Electronic and charted data were collected to monitor compliance with prescribed treatment regimens. All ITD allowed Wi-Fi access to allow teens to explore BD Web sites and knowledge was assessed.
  
  
  RESULTS
  Twenty-three of 45 subjects completed the study. The mean age was 14.1 ± 1.9 years. Subjects who were compliant with the ITD (group 1), charted on baseline symptoms, menstrual flow (83.3%), cramps (100%, 23/23), breakthrough bleeding (95.6%, 22/23), mood (95.6%, 22/23), and medication use (91.7%) for a mean of 9.3 ± 3.1 months. Subjects who were nonusers (group 2) did not report on symptoms, their condition, or medication use in the device (n = 22). More than 75% (17/23) of subjects in group 1 used hormones alone or hormones with antifibrinolytic agents to control HMB. No subjects stopped or missed medications who were in group 1 intentionally, and also there were 9 enrollees within this same group who missed a medication related to awaiting the prescription to be filled from pharmacy. In group 2, 17 enrollees missed medications, resulting in 19% (4/22) of these enrollees being admitted to hospital for 1-2 days. In addition, enrollees in group 2 missed more medications on average compared with group 1. No subjects in group 1 required admission for HMB treatment failure during the study period, compared with those in group 2 (P = .006). All subjects in group 1 reported accessing Web sites using their ITD to learn about their BD. Groups 1 and 2 did not differ in the number of medications that were prescribed during the time frame (P = .77) or the number of follow-up clinic visits (P = .49). Furthermore, those in group 1 reported fewer breakthrough bleeding episodes than those in group 2 according to clinic notes (P = .03). Users of the ITD were given a set of knowledge questions. Group 2 subjects were not consistent users of the ITD use and did not complete the knowledge questions. Group 1 and 2 could not be compared with regard to knowledge as a result.
  
  
  CONCLUSIONS
  ITD is an excellent tool for adolescents with HMB and BD to allow self-monitoring, provider monitoring, and improve educational access through engaging technology; compliance with device use was associated with several parameters suggestive of improved clinical outcomes.
authors.affiliation: Division of Pediatric and Adolescent Gynecology Baylor College of Medicine and Texas Children's Hospital, Houston, Texas. Electronic address: jedietri@bcm.edu.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Dietrich
authors.affiliation: Division of Pediatric Hematology and Oncology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Yee
authors.affiliation: Division of Pediatric and Adolescent Gynecology Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
authors.forename: Xiomara M
authors.initials: XM
authors.lastname: Santos
authors.affiliation: Division of Pediatric and Adolescent Gynecology Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Bercaw-Pratt
authors.affiliation: Division of Pediatric and Adolescent Gynecology Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kurkowski
authors.affiliation: Division of Pediatric Hematology and Oncology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
authors.forename: Heather
authors.initials: H
authors.lastname: Soni
authors.affiliation: Division of Pediatric Hematology and Oncology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
authors.forename: Youngna J
authors.initials: YJ
authors.lastname: Lee-Kim
authors.affiliation: Division of Pediatric Hematology and Oncology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
authors.forename: Mona D
authors.initials: MD
authors.lastname: Shah
authors.affiliation: Division of Pediatric Hematology and Oncology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
authors.forename: Donald
authors.initials: D
authors.lastname: Mahoney
authors.affiliation: Division of Pediatric Hematology and Oncology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
authors.forename: Lakshmi V
authors.initials: LV
authors.lastname: Srivaths
mesh_terms: D000293:Adolescent; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D005260:Female; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D055539:MP3-Player; D008595:Menorrhagia / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D008796:Metrorrhagia / Q000209:etiology / Q000523:psychology / Q000628:therapy; D063731:Mobile Applications; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D011446:Prospective Studies; D012648:Self Care / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D006728:Hormones
keywords: Bleeding disorders; Heavy menstrual bleeding; Innovative technology; Patient compliance