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Rosa D, Peverelli M, Poliani A, Villa G, Manara DF. Exploring Hypertension Patient Engagement Using mHealth. A Scoping Review. High Blood Press Cardiovasc Prev 2024:10.1007/s40292-024-00656-y. [PMID: 38913296 DOI: 10.1007/s40292-024-00656-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 06/01/2024] [Indexed: 06/25/2024] Open
Abstract
INTRODUCTION Widespread use of smartphone applications has opened new perspectives for home Blood Pressure monitoring based on mobile health (mHealth) technologies. Patient engagement has been dubbed 'the silver bullet of the century'. AIM The aim was to identify the impact of engagement in patients with blood pressure using mHealth. METHODS This scoping review was conducted in accordance with the Ark0sey and O'Malley framework. DATABASE Pubmed, CINAHL, Scopus and PsycInfo. This review considered both qualitative and quantitative primary searches. We excluded articles belonging to grey literature, secondary literature and paediatric setting. Between September and November 2023, the review was carried out. RESULTS A total of 569 documents were retrieved from the four databases. After the deduplication process, five articles were removed. The selection process based on titles and abstracts included 133 records. Ten studies were selected and analysed. The reviewers identified the following themes: device type and mobile applications, engagement, blood pressure control, health behaviours and hypertension knowledge. Self-management using digital technologies in the home is strongly linked to engagement, reduction and control of Blood Pressure, improved health practices and increased knowledge of hypertension. Healthcare interventions using IT platforms have had a significant impact on the health outcomes of patients diagnosed with hypertension. CONCLUSIONS The review findings suggest the value of these technologies in improving patient engagement and, consequently, adherence to antihypertensive treatment and achieving blood pressure control rates, potentially reducing cardiovascular risk.
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Affiliation(s)
- Debora Rosa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Via Olgettina, 58, Milan, Italy
| | - Matteo Peverelli
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Via Olgettina, 58, Milan, Italy
| | - Andrea Poliani
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Via Olgettina, 58, Milan, Italy
| | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Via Olgettina, 58, Milan, Italy.
| | - Duilio Fiorenzo Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Via Olgettina, 58, Milan, Italy
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Moosa AS, Oka P, Ng CJ. Exploring primary care physicians' challenges in using home blood pressure monitoring to manage hypertension in Singapore: a qualitative study. Front Med (Lausanne) 2024; 11:1343387. [PMID: 38590317 PMCID: PMC10999538 DOI: 10.3389/fmed.2024.1343387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
Objective Hypertension guidelines recommend using home blood pressure (HBP) to diagnose, treat and monitor hypertension. This study aimed to explore the challenges primary care physicians (PCPs) face in using HBP to manage patients with hypertension. Method A qualitative study was conducted in 2022 at five primary care clinics in Singapore. An experienced qualitative researcher conducted individual in-depth interviews with 17 PCPs using a semi-structured interview guide. PCPs were purposively recruited based on their clinical roles and seniority until data saturation. The interviews were audio-recorded, transcribed verbatim and managed using NVivo qualitative data management software. Analysis was performed using thematic analysis. Results PCPs identified variations in patients' HBP monitoring practices and inconsistencies in recording them. Access to HBP records relied on patients bringing their records to the clinic visit. A lack of seamless transfer of HBP records to the EMR resulted in an inconsistency in documentation and additional workload for PCPs. PCPs struggled to interpret the HBP readings, especially when there were BP fluctuations; this made treatment decisions difficult. Conclusion Despite strong recommendations to use HBP to inform hypertension management, PCPs still faced challenges accessing and interpreting HBP readings; this makes clinical decision-making difficult. Future research should explore effective ways to enhance patient self-efficacy in HBP monitoring and support healthcare providers in documenting and interpreting HBP.
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Affiliation(s)
- Aminath Shiwaza Moosa
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | - Prawira Oka
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | - Chirk Jenn Ng
- SingHealth Polyclinics, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
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Einhorn J, Murphy AR, Rogal SS, Suffoletto B, Irizarry T, Rollman BL, Forman DE, Muldoon MF. Automated Messaging Program to Facilitate Systematic Home Blood Pressure Monitoring: Qualitative Analysis of Provider Interviews. JMIR Cardio 2023; 7:e51316. [PMID: 38048147 PMCID: PMC10728784 DOI: 10.2196/51316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Hypertension is a leading cause of cardiovascular and kidney disease in the United States, yet blood pressure (BP) control at a population level is poor and worsening. Systematic home BP monitoring (HBPM) programs can lower BP, but programs supporting HBPM are not routinely used. The MyBP program deploys automated bidirectional text messaging for HBPM and disease self-management support. OBJECTIVE We aim to produce a qualitative analysis of input from providers and staff regarding implementation of an innovative HBPM program in primary care practices. METHODS Semistructured interviews (average length 31 minutes) were conducted with physicians (n=11), nurses, and medical assistants (n=6) from primary care settings. The interview assessed multiple constructs in the Consolidated Framework for Implementation Research domains of intervention characteristics, outer setting, inner setting, and characteristics of individuals. Interviews were transcribed verbatim and analyzed using inductive coding to organize meaningful excerpts and identify salient themes, followed by mapping to the updated Consolidated Framework for Implementation Research constructs. RESULTS Health care providers reported that MyBP has good ease of use and was likely to engage patients in managing their high BP. They also felt that it would directly support systematic BP monitoring and habit formation in the convenience of the patient's home. This could increase health literacy and generate concrete feedback to raise the day-to-day salience of BP control. Providers expressed concern that the cost of BP devices remains an encumbrance. Some patients were felt to have overriding social or emotional barriers, or lack the needed technical skills to interact with the program, use good measurement technique, and input readings accurately. With respect to effects on their medical practice, providers felt MyBP would improve the accuracy and frequency of HBPM data, and thereby improve diagnosis and treatment management. The program may positively affect the patient-provider relationship by increasing rapport and bidirectional accountability. Providers appreciated receiving aggregated HBPM data to increase their own efficiency but also expressed concern about timely routing of incoming HBPM reports, lack of true integration with the electronic health record, and the need for a dedicated and trained staff member. CONCLUSIONS In this qualitative analysis, health care providers perceived strong relative advantages of using MyBP to support patients. The identified barriers suggest the need for corrective implementation strategies to support providers in adopting the program into routine primary care practice, such as integration into the workflow and provider education. TRIAL REGISTRATION ClinicalTrials.gov NCT03650166; https://tinyurl.com/bduwn6r4.
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Affiliation(s)
| | - Andrew R Murphy
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Shari S Rogal
- Dissemination and Implementation Science Collaboration, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Division of Gastroenterology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Brian Suffoletto
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Taya Irizarry
- Department of Advanced Analytics and Population Health, Highmark Health Enterprise, Pittsburgh, PA, United States
| | - Bruce L Rollman
- Center for Behavioral Health, Media and Techology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Daniel E Forman
- Division of Geriatrics, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Geriatrics, Reseach, Education and Clinical Care (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Matthew F Muldoon
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- UPMC Hypertension Center, Heart and Vascular Institute, UPMC Healthcare System, Pittsburgh, PA, United States
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Hashemi-Arend A, Vasquez KS, Guishard D, Naji M, Ronning A, George-Alexander G, Vasquez D, Sylvester C, Pagano W, Khalida C, Coffran C, Ezeonu T, Fofana K, Bielopolski D, Vaughan R, Qureshi A, Tobin JN, Kost RG. Implementing DASH-Aligned Meals and Self-Measured Blood Pressure to Reduce Hypertension at Senior Centers: A RE-AIM Analysis. Nutrients 2022; 14:4890. [PMID: 36432576 PMCID: PMC9699075 DOI: 10.3390/nu14224890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Low-income, minority seniors face high rates of hypertension that increase cardiovascular risk. Senior centers offer services, including congregate meals, that can be a valuable platform to reach older adults in underserved communities. We implemented two evidence-based interventions not previously tested in this setting: DASH-aligned congregate meals and Self-Measured Blood Pressure (SMBP), to lower blood pressure (BP) at two senior centers serving low-income, racially diverse communities. The study enrolled congregate meal program participants, provided training and support for SMPB, and nutrition and BP education. DASH-aligned meals delivered 40% (lunch) or 70% (breakfast and lunch) of DASH requirements/day. Primary outcomes were change in BP, and BP control, at Month 1. Implementation data collected included client characteristics, menu fidelity, meal attendance, SMBP adherence, meal satisfaction, input from partner organizations and stakeholders, effort, and food costs. We used the RE-AIM framework to analyze implementation. Study Reach included 94 older, racially diverse participants reflecting neighborhood characteristics. Effectiveness: change in systolic BP at Month 1 trended towards significance (-4 mmHg, p = 0.07); change in SMBP reached significance at Month 6 (-6.9 mmHg, p = 0.004). We leveraged existing community-academic partnerships, leading to Adoption at both target sites. The COVID pandemic interrupted Implementation and Maintenance and may have attenuated BP effectiveness. DASH meals served were largely aligned with planned menus. Meal attendance remained consistent; meal satisfaction was high. Food costs increased by 10%. This RE-AIM analysis highlights the acceptability, feasibility, and fidelity of this DASH/SMBP health intervention to lower BP at senior centers. It encourages future research and offers important lessons for organizations delivering services to older adults and addressing cardiovascular risk among vulnerable populations.
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Affiliation(s)
- Anuradha Hashemi-Arend
- Center for Clinical Translational Science, The Rockefeller University, New York, NY 10065, USA
| | - Kimberly S. Vasquez
- Center for Clinical Translational Science, The Rockefeller University, New York, NY 10065, USA
| | | | - Moufdi Naji
- Carter Burden Network, New York, NY 10021, USA
| | - Andrea Ronning
- Center for Clinical Translational Science, The Rockefeller University, New York, NY 10065, USA
| | - Glenis George-Alexander
- Center for Clinical Translational Science, The Rockefeller University, New York, NY 10065, USA
| | - Dacia Vasquez
- Center for Clinical Translational Science, The Rockefeller University, New York, NY 10065, USA
| | | | - William Pagano
- Clinical Directors Network (CDN), New York, NY 10018, USA
| | | | - Cameron Coffran
- Center for Clinical Translational Science, The Rockefeller University, New York, NY 10065, USA
| | - Teeto Ezeonu
- Center for Clinical Translational Science, The Rockefeller University, New York, NY 10065, USA
| | - Kadija Fofana
- Center for Clinical Translational Science, The Rockefeller University, New York, NY 10065, USA
| | - Dana Bielopolski
- Center for Clinical Translational Science, The Rockefeller University, New York, NY 10065, USA
| | - Roger Vaughan
- Center for Clinical Translational Science, The Rockefeller University, New York, NY 10065, USA
| | - Adam Qureshi
- Center for Clinical Translational Science, The Rockefeller University, New York, NY 10065, USA
| | - Jonathan N. Tobin
- Center for Clinical Translational Science, The Rockefeller University, New York, NY 10065, USA
- Clinical Directors Network (CDN), New York, NY 10018, USA
| | - Rhonda G. Kost
- Center for Clinical Translational Science, The Rockefeller University, New York, NY 10065, USA
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