Using Text Messaging to Communicate with Adolescent Heart Transplant Patients

Purpose Pediatric heart transplant (PHTx) patients require life-long medication and follow up. Adolescents are a vulnerable population with multifactorial reasons for non-adherence to their medical needs. Adherence may depend on the cognitive skills required to plan and to self-regulate, referred to as executive function (EF). Deficits in EF are associated with medication non-adherence. Facilitating consistent communication between adolescents and their health care providers (HCP) via a short messaging service (SMS) platform allows for regular communication and may improve quality of life (QoL) and medication compliance. Methods In collaboration with WelTel, we have implemented a secure, healthcare-specific SMS platform for PHTx aged 12-18 years. At enrollment, EF was assessed by both patient and parent reports using the BRIEF2 (reported global executive composite (GEC) T-score). PedsQL questionnaires and surveys to assess patient engagement with the SMS platform were measured at enrollment and will be reassessed after 1 year. Change in serum immunosuppression levels from baseline to 1 year post SMS intervention will be used as a surrogate measure of medication compliance. Patient response rate and number of care conversations (≥3 messages) were reviewed. Results We report preliminary data on 17 eligible PHTx. Eight have enrolled, 9 in total did not due to a lack of interest (n=2), no access to a cellular phone (n=5), and developmental delay (n=2). At baseline the BRIEF2 did not demonstrate any clinically significant abnormalities in EF, with all scores below the threshold of 70 (mean patient GEC T-score = 52.4, range 39-68; mean parent GEC T-score = 50, range 39-61). Median baseline QoL score was 85 (Range 70-98; healthy adolescents= 83+/-15). Patients have been connected to the SMS network for a median duration of 3.4 months (1.2 - 8.0 months) and there have been a total of 551 messages with 89 that have consisted of a conversation of ≥3 messages. Conclusion We present a novel mode of communication between adolescent PHTx and their healthcare providers. At baseline there is no impairment in EF and QoL is consistent with healthy adolescents. Patients that are enrolled have demonstrated frequent communication using the SMS platform since its introduction. The long-term impact of increased communication on QoL and medication compliance will be reviewed after 1 year.