Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health


Health Services Research & Administration

First Committee Member

Hongmei Wang

Second Committee Member

Jianghu Dong

Third Committee Member

Donald Klepser


Poor adherence to medication regimens is responsible for 30-70% of all medication-related hospital admission in the United States and can be calculated to cost approximately $100 billion per year (Burra et al., 2011). The purpose of this pre-post cohort analysis is to measure the impact of using a mobile phone application and text messaging service on the medication possession ratio (MPR), a measure of adherence, among solid organ transplant patients who fill at Nebraska Medicine Outpatient Pharmacy. These interventions make it more convenient for patients to request refills, for pharmacy staff to send push notifications, and automatic refill and/or pickup reminders to be generated. Higher medication adherence rates to immunosuppressive agents, along with all other medications, promote better long-term outcomes such as: longevity of transplanted organ and prevention of adverse events. I hypothesize a positive association between the use of a mobile phone application and/or text messaging service and the MPR. 59 patients were identified in pharmacy software, McKesson, that had voluntarily used the mobile phone application and/or text messaging service prior to 6/12/2020. Each patient’s MPR was manually derived for one year before intervention (6/12/2019-6/11/2020) and one year after intervention (6/12/2020-6/12/2021). MPR is the sum of the days’ supply for all fills of a given drug in a particular time period, divided by the number of days in the time period (1 year). The sample characteristics were examined and reported in terms of type of transplant, sex, race, and age. Then t-tests were conducted to examine if MPR is associated with age, sex, race, or type of transplant at baseline, one-year pre-intervention, and one-year post-intervention. Then, a multiple linear regression was run to examine if there were significant change in patient MPR over the two years after controlling age, sex, race, and type of transplant in the model. The results of the two-tailed, paired t-test comparing the average MPR in year 2020-2021 to that of year 2019-2020 returned a p-value of 0.31, indicating no statistically significant differences between these two years. This result does not support our hypothesis that the use of a mobile phone application and/or text messaging service will increase the MPR of solid organ transplant patients. In conclusion, analyzing the effect of the same intervention on a larger patient population with a lower baseline MPR, such as diabetic patients, would be more powerful using the same pre-post study design.

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