Implementing a Home-Based Telehealth Group Adherence Intervention with Adolescent Transplant Recipients.
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INTRODUCTION To improve access to care and engage adolescent transplant recipients for adherence promoting interventions innovative solutions utilizing technology are needed MATERIALS AND METHODS This study describes the implementation of a five session group intervention targeting medication adherence in adolescent transplant recipients through home based telemedicine RESULTS Seven videoconferencing groups were conducted with a total of 33 participants living a median of 57 miles away from their transplant medical center The median coefficient of variation CV of tacrolimus immunosuppression medication decreased from 32 2 to 23 5 from the pregroup to postgroup phase Analyses indicated that the group was acceptable and engaging for participants as highlighted by one participant reporting I liked how me and the group members came together it felt like a little family Overall satisfaction with the group and with the technology was endorsed by 86 The group intervention was generally feasible however there were technological difficulties reported by participants and the facilitator particularly given the diversity of the home based connections and equipment Other adaptations helped improve recruitment attendance and participation DISCUSSION Implementing a telehealth group can pose unique challenges especially with a group of adolescent participants Although nonsignificant we observed a decrease in the median CV of tacrolimus indicating that medication adherence generally improved after group intervention Our experience facilitating these groups provides insights into strategies to optimize feasibility and the participant experience Distance of participants from the hospital is an important consideration and provides a strong rationale for the need for telemedicine enabled approaches We explore and discuss the challenges to implementing a home based group suggest practical strategies and developmentally sensitive adjustments when working with adolescents and propose strategies to prepare clinicians for obstacles that may present when implementing a telehealth group with youth