1. http://sctr.musc.edu 843-792-8300 Pilot Feasibility Clinical Trial: Telemedicine Infused Adherence Enhancement for Renal Transplant Patients Subtitle Presenters Date John W McGillicuddy, MD Frank A Treiber, PhD Martina Mueller, PhD Gayenell S Magwood, PhD, RN Gail Johnson, MS Presented: Verizon Wireless Health Technology Initiative Meeting, Nov. 15, 2011

2. http://sctr.musc.edu 843-792-8300 Rationale ESRD afflicts more than 500,000 people in the USA HTN and DM are the #1 and #2 causes of ESRD Kidney transplantation is the treatment of choice for ESRD Kidneys are an incredibly scarce resource which mandates that their use be optimized Despite significant advances, average graft survival is suboptimal at approximately 9 years Graft survival is worse among African-Americans and those of lower socioeconomic status

3. http://sctr.musc.edu 843-792-8300 Rationale Medication nonadherence is key contributor to premature graft loss Approximately 35% of renal transplant patients are nonadherent and issues often develop within weeks of transplantation Medication nonadherence contributes to graft loss by allowing for immune mediated rejection and the deleterious effects of poorly controlled HTN and DM Mobile health technology has the potential to improve medication adherence, blood pressure and blood sugar control, and graft survival

4. http://sctr.musc.edu 843-792-8300 Aim Utilize wireless technology to identify nonadherent patients early after transplant and to interact with them in real time to improve adherent behaviors as a means to improve: Medication adherence Control of HTN Control of DM Graft survival

5. http://sctr.musc.edu 843-792-8300 Study Design and Methods Type: Randomized control trial Subjects: 20 nonadherent kidney transplant patients Methods: randomly assigned to: Group A: standard post operative care Group B: “bundled” wireless real time medication reminder system, blood pressure/blood glucose monitoring, cognitive behavior adherence skills enhancement program

6. http://sctr.musc.edu 843-792-8300 Study Design and Methods Technology Maya MedMinder to monitor and aid in medication adherence Bluetooth enabled Fora D15b to measure and record BP and blood glucose “Smart” phones for signal transmission “Smart” phones for patient interaction Cognitive behavioral enhancement techniques via video conferencing with adherence coach

7. http://sctr.musc.edu 843-792-8300 Study Design and Methods Outcomes (measured pre-, 1, 2, and 3 months): Medication adherence (Maya MedMinder) Blood pressure control (Fora D15b, 24h ambulatory BP) Blood glucose control (Fora D15b, HgbA1c) Immunosuppression (FK506 variability)

9. Approximately $450.00. Power drain from Bluetooth data transfer. Easy to lose.

10. Content TENSION TAMER http://sctr.musc.edu 843-792-8300 Presented by the COLLEGES of NURSING and MEDICINE

11. http://sctr.musc.edu 843-792-8300 Study Design and Methods