JMIR Publications

ABSTRACT

Background:

Hypertension (HTN) is a prevalent and costly burden in the United States. Clinical pharmacists, who assist patients in managing chronic conditions in primary care clinics, are effective for the management of HTN, as is home blood pressure (BP) monitoring; however, concerns about data quality and latency are widespread in instances where patients maintain paper-based logs for self-monitoring. One prospective approach to close the gap between clinical pharmacist intervention and home BP monitoring is the use of mobile health (mHealth) technology.

Objective:

The goal of this study was to investigate the feasibility, acceptability, and preliminary effectiveness of BPTrack, a clinical pharmacist-led intervention that makes electronically-collected data available to the pharmacist in real-time for HTN management. Additionally, this study aims to understand barriers to adoption and areas for improvement identified by key stakeholders, so that more widespread use of such interventions may be achieved.

Methods:

We conducted a mixed method pilot study of BPTrack, with the aim to improve BP control in patients with uncontrolled hypertension through a 12-week pre-/post-intervention. All patients were recruited from a primary care setting where they worked with a clinical pharmacist for HTN management. Participants completed a baseline visit, then spent 12 weeks utilizing the intervention at home before returning for a follow-up visit. Data for this pilot study included patient participant surveys both pre-/post- intervention, patient participant clinical measures (BP and medication adherence), patient participant utilization of the BPTrack app, patient participant interviews at follow-up, patient participant chart review, and key stakeholder interviews.

Results:

We enrolled 15 patient participants (retained 13, 86.7% retention rate). Data from all sources supported the idea that BPTrack was feasible and acceptable for use by both patient and provider participants, and was effective at reducing BP in participants. At 12-week follow-up, patient participants exhibited significant reductions in both systolic BP (baseline mean = 137.3 mmHg (SD=11.1 mmHg), follow-up mean = 131.0 mmHg (SD=9.9 mmHg), P=.02) and diastolic BP (baseline mean = 89.4 mmHg (SD=7.7 mmHg); follow-up mean = 82.5 mmHg (SD=8.2 mmHg); P=.0008). Improvements in medication adherence were not noted. Analysis of interview data revealed there was room for improvement and refinement for the patient experience. Furthermore, stakeholders require EHR integration and modified clinical workflow for BPTrack to be truly useful; however, both patients and stakeholders perceived benefits of BPTrack when used within the context of a clinical relationship.

Conclusions:

Our results demonstrate that a pharmacist-led mobile health intervention that promotes home BP monitoring and clinical pharmacist management of hypertension can be effective at reducing BP in primary care patients with uncontrolled hypertension. Our data also support the idea that these types of interventions are feasible and acceptable to patients and providers. Clinical Trial: ClinicalTrials.gov NCT02898584