Purpose: Impact of nonadherence among transplant recipients has been well documented as a significant contributor of allograft failure. The objective of this study was to compare medication adherence among transplant recipients who fill their tacrolimus prescriptions through the internet or on a mobile app versus those who fill through traditional methods over a one-year period.

Methods:This retrospective,observational cohort study used administrative claims data from a large, U.S.pharmacy chain.Medication adherence was measured by proportion of days covered(PDC). The study sample included transplant recipients aged18+ with at least two pharmacy claims for tacrolimus at least 150 days apart between 2013 and 2016; each patient was followed for 12-months from their first fill in the study period.The intervention group was matched 1:1 to the control group based on the following baseline characteristics: age group, gender, payor, number of comorbid conditions, annual copay, use of brand medications and use of a transplant specialized pharmacy [TSP]. Logistic regression was used to estimate the difference in medication adherence between the intervention group, patients who use digital methods for refills, and control group. The independent variable, digital use, was measured as patients who use digital methods for over 50% of their fills. The dependent variable, medication adherence, was measured as PDC ≥80% over a 12-month period.

Results: Propensity score matching resulted in 1,166 patients in each group. After adjusting for covariables, transplant recipients who refilled their medications through the internet or by scan were 1.70 times more likely to be adherent than those who filled their prescriptions through other methods (95% CI [1.40, 2.00]; p<.001). A sensitivity analysis using logistic regression and adjusting for covariables without matching showed those refilling through the internet or by scan were 1.45 times more likely to be adherent (95% CI [1.40, 2.00]; p<.001).

Conclusion: The results showed that transplant recipients who refilled their prescriptions through digitally-enabled platforms compared to traditional methods were more adherent over a one-year period. Limitations of the study include its observational design and a reliance on administrative data from one pharmacy chain. Digital engagement tools provide patients more convenience and flexibility, which may help improve patient adherence to treatment plans.

CITATION INFORMATION: Boghani S., Kirkham H., Pietradoni G., Hira N. Digital-Enabled Refills and Medication Adherence among Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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