Purpose

Therapeutic drug monitoring (TDM) of immunosuppressants is critical to avoid rejection or toxic side effects by under- or over-immunosuppression after heart transplantation (HTx). Hence, in this study we evaluate if information and communication technology (ICT)-support has a potential for electronic health (ehealth) service to enhance TDM after HTx.

Methods

We designed and established a project pathway to conceptualise the deployment of a ehealth service by using insights of technical and conceptual needs (status-quo process) and a patient survey using a standardized questionnaire to assess e.g. patient satisfaction, technical questions and demands related to ehealth were combined to develop step by step a full scope ICT-support for TDM after HTx.

Results

The results of the patient survey, with 88.5% (n=138 from 156) return, showed that the current work-flow and organisational interfaces including hospital internal as well as external stakeholders were not clearly standardized: (1) nearby 50% did not have an answering machine connected to their home telephone; (2) the actual state of TDM manifests as mainly paper based; (3) mostly the nursing stuff communicated by telephone with the patients about the required drug dose adjustments; (4) the current health status of the patient was missed; (5) only half of the patients did have an internet access or an email address; (6) 66% of the patients had a simple mobile phone for SMS and calls, whereas 22% did not have a mobile phone at all.

Conclusion

Our study showed that a profound ICT-support could be the basis for an enhanced TDM. Such an ehealth service could impact the health care costs positively by reducing hospitalisation periods and rates, by avoiding life threatening situations (e.g. graft rejection) and toxic drug side effects, and by establishing a continuous data exchange rate with a short reaction time between the stakeholders.

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