Mt. Sinai, CareSpeak text liver transplant patients

By Brian Dolan
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CareSpeak“If we can save one patient from needing another transplant, we’ve saved a life and at least a half-million dollars. The investment is relatively little and the benefit enormous.” Dr. Tamir Miloh, assistant professor of pediatrics and surgery at Mount Sinai Hospital in New York. The investment? Text message reminders for teenage liver transplant patients.

Miloh and his team at Mt. Sinai worked on a pilot program with with CareSpeak that aimed to increase the rate of adherence among young liver transplant patients to their medication regimen. The medication schedule for the program's 41 patients ranged from three different pills once a day to three different pills twice a day.

Results from Mt. Sinai

According to a report in the journal, Pediatrics, investigators concluded that the text message reminders did in fact increase adherence to regimens, but more importantly it led to better outcomes: While 12 of the 41 patients had experienced rejection episodes during the year before starting the program, only two patients had such an episode during the program.

How CareSpeak works

CareSpeak and Mt. Sinai set up the program so that each patient could customize when she or he would receive their reminders -- right before the dose was due, an hour before, etc. Patients could also choose how many reminders they would receive throughout the day: They could choose to have multiple reminders leading up to a dose, for example. An hour after taking their medication, teenagers had to text back that they had taken them, if they didn't, their care giver or parent would get an alert to get on their case.

The biggest challenge

Researchers paid for the text messaging, but almost one third of the patients dropped out because they either lost their phone privileges or could no longer afford their phone services. (That's an amazing figure -- wonder why a parent would take away "phone privileges" when a child was depending on it to keep their liver healthy?)

(UPDATE: CareSpeak CEO Srdjan Loncar wrote in to clarify: "The drop outs seemed to be due to two things: (a) the patient had a pre-paid phone and ran out of credit, or (b) in the case of post-paid customers they didn’t pay their bill and were 'blacklisted' by carrier, i.e. They shut down their service." That makes much more sense than the patients "lost their phone privileges" as the New York Times explained -- certainly leads the reader to assume parents were involved with the decision.)

“In the future, we are hoping that insurance companies might support some kind of text message system for their patients,” Dr. Miloh said. “ ... This kind of communication can only help to enhance the relationship between patients and their clinicians."

For more, be sure to read the entire NYTimes article here
Or watch this presentation about the Mt. Sinai, CareSpeak program