Please select the eligibility criteria that correspond to the clinical trial below.
Title: Randomized Prospective Trial of Telemedicine Based Remote Home Monitoring After Liver Transplantation
Brief Summary: A significant opportunity exists to involve patients and their caregivers in more effective perioperative care and transition to home for transplant patients. Stakeholders were engaged through the University of Cincinnati Liver Transplant Program to prioritize changes in improving post transplant care. The initial findings indicated that increasing "care between visits" is the top priority for patients for improving function, quality of life and independence. Building on existing telehealth research, an enhanced home management program (HMP) to leverage and improve patient self-care following liver transplantation was developed, specifically by improving adherence, reducing readmissions and improving the transition from hospital to home. The improvement of care may have profound effect in the first 90 days after transplant on important long-term health parameters that affect clinical outcomes such as depression, weight gain, blood pressure control and diabetes management. With patient engagement, a randomized controlled trial is proposed comparing traditional provider-based care vs. traditional care with HMP. These two arms will need 50 patients in each arm with a 0.5 year follow up. Patients have said that the primary outcomes are quality of life, function and independence. To that end, the primary study outcomes are assessment of adherence, readmissions (90-day), patient satisfaction. The HMP model will advise providers, health care systems, and transplant centers how to improve patient care, especially among those at greatest risk of poor outcomes specifically minorities and those of low socioeconomic status.


Options:
A: Inclusion Criteria:

* all patients undergoing solid organ transplantation at Toronto General Hospital during the study period

Exclusion Criteria:

* non-English speaking/reading
* no internet access at home
* planned discharge to a rehab facility without internet access
* not on a calcineurin inhibitor (CNI) or sirolimus
* attending the Self Medication class on the same day as hospital discharge
* cognitive impairment that precludes participation in Self Medication program (as per the assessment of the transplant pharmacist)
* incapable of providing informed consent
B: Inclusion Criteria:

* patients who underwent renal transplantation aged ≥18 years old,
* who signed the informed consent,
* who underwent follow-up post transplant clinic at the Hospital do Rim for 3 months,
* receiving immunosuppressive drugs tacrolimus, prednisone and sodium mycophenolate or tacrolimus, azathioprine, and prednisone.

Exclusion Criteria:

* were patients who underwent second kidney transplant,
* which did not follow the Hospital do Rim after transplant and who were participating in some other study with pharmaceutical intervention.
C: Inclusion Criteria:

* a minimum of one year post renal transplant with a successful kidney graft and stable renal function (estimated glomerular filtration rate \[GFR (glomerular filtration rate)\] above 25 ml/minute per 1.73 m2).
* currently prescribed tacrolimus
* able to swallow pills
* a minimum of grade six education
* fluent in the English language.

Exclusion Criteria:

* refusal to or inability to give written informed consent.
* any visual, hearing or other sensory/motor impairments which may interfere with the testing procedures.
* have had a stroke determined to be of significant severity
* have had a head injury determined to be of significant severity
* have a current psychiatric diagnosis determined to be of significant severity
* have the presence of an acute illness (e.g., metastatic cancer), neurological disease, and other major organ failure (e.g., end stage liver disease)
D: Inclusion Criteria:

1. Male and female subjects (≥ 18 years old) who are liver transplant recipients.
2. Discharged home within 45 days of liver transplant.
3. Able and willing to provide informed consent.

Exclusion Criteria:

1. Post-transplant admission and care provided by University of Cincinnati Medical Center or rehab facility \> 45 days after liver transplant.
2. Unable to have 4G wireless connectivity or wifi in their home.
3. Patient has any form of psychiatric disorder or a condition that, in the opinion of the investigator, may hinder communication with the investigator.
4. Inability to cooperate or communicate with the investigator.

Answer: D