Towards a mobile system for hypertensive outpatients' treatment adherence improvement

Covering more than a third of the population, arterial hypertension is a debilitating disease resulting in the adverse effect on the physical and emotional state of the patient and, hence, exerting the negative influence on the patient health- related quality of life. Treatment of hypertension involves the use of specific drug therapy along with a modification of a lifestyle and a diet over a long-term period. This, in turn, leads to the low adherence to the treatment among the ambulatory patients and, as a consequence, increases the chances of the hypertension-related complications, including the risk of sudden cardiac death. To address the problem of low adherence, we have previously proposed the mobile personal monitoring and assisting system constructed on the principles of smart spaces. The system relies on joint processing of both objective and subjective health measures accumulated in semantic ontology-driven storage enabling the construction of the personalized assisting services. In this paper, we extend the approach putting into consideration behaviour activities and interventions. Moreover, we propose the adherence assessment method based on the variety of user engagement measures, which also can be divided into subjective questionnaire-based measures, and objective metrics based on behaviour analysis and mobile app analytics

The Effectiveness Of Telemonitoring In Treatment Adherence Cardiovascular Disease: A Systematic Review

Background. Cardiovascular disease is one of the leading causes of death in the world. The most important things as a determinant of success in the prevention of risk factors, controlling symptoms, delay the progression of the disease and prevent hospitalization in patients with cardiovascular disease are patients adherence to therapeutic regimens. Non-adherence to long-term therapy is still a global problem especially in chronic diseases such as cardiovascular disease. This requires the development of easy interventions, and can be applied in everyday practice. Methods: Systematic review consists of 5 steps: (1) identification of the instrument in the literature (database search); (2) identification of relevant literature based on the title and abstract; (3) inclusion and exclusion criteria; (4) obtain full text of the literature; (5) grading is based on components of the literature and analysis of the selected instrument. Search articles using the PICOT framework in the database; Ebscho, Science Direct, Elseiver, Sage Journals, Scopus, ProQuest, Journal Ners, limited to the last 7 years, 2010 to 2017 obtained 15 International Journal. Results: The magnitude and significant of telemonitoring effect on adherence in patient with cardiovascular disease. Conclusion: intervention with SMS system combined with smartphone gives good result in adherence patients with cardiovascular disease

Application of Mobile Health Services to Support Patient Self-Management of Chronic Conditions

Background: Chronic conditions are the leading cause of ill-health, disability and premature death, adding huge health and socioeconomic burden to the healthcare system. Although mobile health (mHealth) services have the potential to provide patients with a timely, ubiquitous, and cost-effective means to access healthcare services, to date, much remains to be revealed for their application in chronic condition management. Aim: This doctoral project aims to comprehensively understand the application of mHealth services to support patient self-management of chronic conditions. This aim is achieved through four objectives: (1) to synthesise research evidence about health outcomes of applying mHealth services to support patient self-management of chronic conditions and the essential components to achieve these outcomes, (2) to determine the mechanism for applying mHealth services to support patient self-management of chronic conditions, (3) to explore critical factors and how these factors influence patients\u27 intention to continuously use mHealth services, and (4) to apply the above findings to guide the design of a prototype mHealth service. Methods: To increase the generalisability of the findings, three chronic conditions that could benefit from mHealth services were purposively studied to address the research objectives within the feasibility of available study sites and resources at different stages of the project. First, two literature review studies were conducted to achieve Objective 1. One was a systematic review to investigate health outcomes of mHealth services to support patient self-management of one chronic condition, unhealthy alcohol use, and the essential components to achieve these outcomes. The other was a rapid review on using behavioural theory to guide the design of mHealth services that support patient self-management of another chronic condition, hypertension. Second, two field studies were conducted to achieve Objectives 2 and 3, respectively. One was an interview study that explored patients\u27 perceptions of a mHealth service to support their self-management of hypertension in China. The other was a questionnaire survey study conducted on the same site that explored critical factors influencing patients\u27 intention to continuously use the mHealth service. Third, a clinician-led, experience-based co-design approach was implemented to apply the above-mentioned learning experience to the development practice of a mHealth service that supports patient self-management of obesity before elective surgery in Australia, achieving Objective 4. Results: Literature reviews identify five structural components - context, theory, content, delivery mode, and implementation procedure - which are essential for mHealth services to achieve three health outcomes - behavioural, physiological, and cognitive outcomes. Inductive synthesis of the interview findings lead to a 6A framework that summarises the mechanisms for mHealth services: access, assessment, assistance, awareness, ability, and activation. Mobile health services provide patients with easy access to health assessment and healthcare assistance to increase their self-management awareness and ability, thereby activating their self-management behaviours. Questionnaire survey study finds that patients\u27 intention to continuously use mHealth services can be influenced by the information quality, system quality and service quality by influencing their perceived usefulness and satisfaction with the mHealth services. Guided by Social Cognitive Theory, the developed prototype mHealth service provide patients with functions of automatic push notifications, online resources, goal setting and monitoring, and interactive health-related exchanges that encourage their physical activity, healthy eating, psychological preparation, and a positive outlook for elective surgery. The patients\u27 requirements in two focus group discussions enabled the research team to improve the mHealth service design. Conclusion: Mobile health services guided by behavioural theories can provide patients with easy access to health assessment and healthcare assistance to increase their self-management awareness and ability, thereby activating their self-management behaviours. The effort for designing mHealth services needs to be placed on crafting content (to improve information quality), developing useful functions and selecting a proper delivery mode (to improve system quality), and establishing effective implementation procedures (to improve service quality). These will ensure patients\u27 perceived usefulness and satisfaction with mHealth services, increase their intention to continuously use such services, thus supporting long-term patient self-management of chronic conditions. As demonstrated by the design case, the findings of this PhD project can be generalised to guide the design of other mHealth services that aim to support patient self-management of chronic conditions

Evidence and recommendations on the use of telemedicine for the management of arterial hypertension:an international expert position paper

Telemedicine allows the remote exchange of medical data between patients and healthcare professionals. It is used to increase patients’ access to care and provide effective healthcare services at a distance. During the recent coronavirus disease 2019 (COVID-19) pandemic, telemedicine has thrived and emerged worldwide as an indispensable resource to improve the management of isolated patients due to lockdown or shielding, including those with hypertension. The best proposed healthcare model for telemedicine in hypertension management should include remote monitoring and transmission of vital signs (notably blood pressure) and medication adherence plus education on lifestyle and risk factors, with video consultation as an option. The use of mixed automated feedback services with supervision of a multidisciplinary clinical team (physician, nurse, or pharmacist) is the ideal approach. The indications include screening for suspected hypertension, management of older adults, medically underserved people, high-risk hypertensive patients, patients with multiple diseases, and those isolated due to pandemics or national emergencies

II-Indonesian Conference on Clinical Pharmacy

II-Indonesian Conference on Clinical PharmacyOrganized byDepartment of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran ( http://farmasi.unpad.ac.id ).Supported by Department of Pharmacy, Universitas Udayana and School of Pharmacy, Institut Teknologi Bandung.Generalinformation: www.iccp-ofki.com.Keywords-Conference on Clinical Pharmac

Increasing cardiovascular medication adherence:A Medical Research Council complex mHealth intervention mixed-methods feasibility study to inform global practice

AimsTo evaluate a mHealth intervention to increase medication adherence among Iranian coronary heart disease patients.DesignQuantitative-dominant mixed-methods study.Data SourceIranian coronary heart disease patients’ responses and most recent clinical documents as well as responses from Iranian cardiac nurses who participated in this study.MethodsThe study was conducted between September 2015–April 2016 drawing on the Medical Research Council's Framework. Phase one comprised of a patients’ survey and focus groups with cardiac nurses. The automated short message service reminder was piloted in phase two. We recruited 78 patients and randomized to receive either 12-week daily reminders or usual care. The primary outcome was the effect on medication adherence; secondary outcomes were self-efficacy, ejection fraction, functional capacity, readmission rate and quality of life.ResultsFeasibility was evidenced by high ownership of mobile phones and high interest in receiving reminders. Participants in the intervention group showed significantly higher medication adherence compared with the control group.ConclusionThe mHealth intervention was well accepted and feasible with early evidence of effectiveness that needs to be confirmed in a fully powered future randomized clinical trial

Designing a Mobile Recommender System for Treatment Adherence Improvement among Hypertensives

Impelling the ambulatory hypertensive patients to stick to the prescribed treatment throughout a long term is a challenging problem. To address the problem, the personal monitoring system can be used providing the possibility both to gather various health state parameters and life style-related data and to intervene in case the patient does not stick to the appointed instructions. The subsystem related to health state monitoring have been presented in our previous work. In this paper, we introduce the recommender system intended to patient's behavior correction

Evaluating the effectiveness of text messaging and phone call reminders to minimize no show at pediatric outpatient clinics in Pakistan: protocol for a mixed-methods study

Background: Missing health care appointments without canceling in advance results in a no show, a vacant appointment slot that cannot be offered to others. No show can be reduced by reminding patients about their appointment in advance. In this regard, mobile health (mHealth) strategy is to use text messaging (short message service, SMS), which is available on all cellular phones, including cheap low-end handsets. Nonattendance for appointments in health care results in wasted resources and disturbs the planned work schedules.Objectives: The purpose of this study is to evaluate the efficacy of the current text messaging (SMS) and call-based reminder system and further explore how to improve the attendance at the pediatric outpatient clinics. The primary objectives are to (1) determine the efficacy of the current clinic appointment reminder service at pediatric outpatient clinics at Aga Khan University Hospital, (2) assess the mobile phone access and usage among caregivers visiting pediatrics consultant clinics, and (3) explore the perception and barriers of parents regarding the current clinic appointment reminder service at the pediatric outpatient clinics at Aga Khan University Hospital.Methods: The study uses a mixed-method design that consists of 3 components: (1) retrospective study (component A) which aims to determine the efficacy of text messaging (SMS) and phone call–based reminder service on patient’s clinic attendance during January to June 2017 (N=58,517); (2) quantitative (component B) in which a baseline survey will be conducted to assess the mobile phone access and usage among parents/caregivers of children visiting pediatrics consultant clinics (n=300); and (3) qualitative (component C) includes in-depth interviews and focus group discussion with parents/caregivers of children visiting the pediatric consultancy clinic and with health care providers and administrative staff. Main constructs will be to explore perceptions and barriers related to existing clinic appointment reminder service. Ethics approval has been obtained from the Ethical Review Committee, Aga Khan University, Pakistan (4770-Ped-ERC-17).Results: Results will be disseminated to pediatric quality public health and mHealth communities through scientific meetings and through publications, nationally and internationally.Conclusions: This study will provide insight regarding efficacy of using mHealth-based reminder services for patient’s appointments in low- and middle-income countries setup. The finding of this study will be used to recommend further enhanced mHealth-based solutions to improve patient appointments and decrease no show

Nurse-led mobile health intervention to promote cardiovascular medication adherence in a cardiac rehabilitation setting: a pilot feasibility study

Background - Mobile health (mHealth) interventions to promote medication adherence have shown promise; among patients primarily diagnosed with Coronary Heart Disease (CHD), however, there is a lack of evidence for nurse-led mHealth interventions, in this particular group in Iran. Aim - To refine and evaluate a pre-developed nurse-led mHealth intervention to promote cardiovascular medication adherence in Iranian adult, male and female Cardiac Rehabilitation (CR) outpatients. Methods - A quantitative-dominant mixed methods study was conducted drawing upon the Medical Research Council’s (MRC) Framework on the development and evaluation of complex interventions. Phase 1 comprised of a self-completion CHD patients’ survey (n=123) and three focus groups with cardiac nurses (n=23) within three public university-affiliated hospitals in Tehran, which in turn informed Phase 2 (the exploratory trial phase). The automated Short Message Service (SMS) medication reminder was designed based on the dimensions of adherence suggested by the World Health Organisation (WHO) and Bandura’ Self-efficacy Theory. The intervention was refined according to the findings from Phase 1 and then piloted in an Iranian CR setting. Seventy eight CHD patients who were 18 years or older, and had mobile phone access were recruited and randomised to receive either daily SMS reminders (n=39) or usual care (n=39) for 12 weeks. The primary outcome was the effect on cardiovascular medication adherence as measured by the self-reported Morisky Medication Adherence Scale; secondary outcomes explored the feasibility of the mHealth intervention, intervention effect on medication adherence selfefficacy, cardiac ejection fraction, cardiac functional capacity, hospital readmission/ death rate and health-related quality of life. Patient acceptability was assessed through completion of a post-intervention survey. Results - Feasibility was evidenced by high ownership of mobile phones in CHD patients, high application of SMS messaging, positive patients’ perception about the intervention, suboptimal cardiovascular medication adherence and patients’ high interest in receiving SMS reminders for their medications. Participants in the intervention group showed higher self-reporting of medication adherence compared to the usual care group χ2 (2) = 23.447; P<0.001. The Relative Risk (RR) was indicated that it was 2.19 times more likely for the control group to be less adherent to their medications than the intervention group (RR = 2.19; 95% Confidence Interval (CI) 1.5 - 3.19). All secondary outcomes improved in the intervention group at the end of the study. Acceptability was evidenced by participants who received the intervention reporting that they perceived the SMS reminders useful. Conclusion - The SMS medication reminder intervention was well accepted and feasible with significantly higher reporting of medication adherence in Iranian CHD patients. Effect sizes were established for use in future follow-up evaluations of the mHealth intervention