Pharmacy-based hypertension care employing mHealth in Lagos, Nigeria – a mixed methods feasibility study

Abstract

BackgroundAccess to quality hypertension care is often poor in sub-Saharan Africa. Some community pharmacies offer hypertension monitoring services, with and without involvement of medical doctors. To directly connect pharmacy staff and cardiologists a care model including a mobile application (mHealth) for remote patient monitoring was implemented and pilot tested in Lagos, Nigeria. Pharmacists provided blood pressure measurements and counselling. Cardiologists enrolled patients in the pilot program and remotely monitored them, for which patients paid a monthly fee. We evaluated the feasibility of this care model at five private community pharmacies. Outcome measures were retention in care, blood pressure change, quality of care, and patients’ and healthcare providers’ satisfaction with the care model.MethodsPatients participated in the care model’s pilot at one of the five pharmacies for approximately 6–8 months from February 2016. We conducted structured patient interviews and blood pressure measurements at pilot entry and exit, and used exports of the mHealth-application, in-depth interviews and focus group discussions with patients, pharmacists and cardiologists.ResultsOf 336 enrolled patients, 236 (72%) were interviewed at pilot entry and exit. According to the mHealth data 71% returned to the pharmacy after enrollment, with 3.3 months (IQR: 2.2–5.4) median duration of activity in the mHealth-application. Patients self-reported more visits than recorded in the mHealth data. Pharmacists mentioned use of paper records, understaffing, the application not being user-friendly, and patients’ unwillingness to pay as reasons for underreporting. Mean systolic blood pressure decreased 9.9 mmHg (SD: 18). Blood pressure on target increased from 24 to 56% and an additional 10% had an improved blood pressure at endline, however this was not associated with duration of mHealth activity. Patients were satisfied because of accessibility, attention, adherence and information provision.ConclusionPatients, pharmacists and cardiologists adopted the care model, albeit with gaps in mHealth data. Most patients were satisfied, and their mean blood pressure significantly reduced. Usage of the mHealth application, pharmacy incentives, and a modified financing model are opportunities for improvement. In addition, costs of implementation and availability of involved healthcare providers need to be investigated before such a care model can be further implemented.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3740-3) contains supplementary material, which is available to authorized users.

Mapping Evidence of Mobile Health Technologies for Disease Diagnosis and Treatment Support by Health Workers in Sub-Saharan Africa: A Scoping Review

“…The characteristics of the included articles are summarised in Table 2. The 10 included articles comprised three qualitative studies (1,117,118), four cluster randomized control trial (4,11,14,17), one quantitative study (121), and two mixed method studies (119,120). All the included articles were published in English language from 2010 to 2019.…”

“…None of the 10 included primary studies reported evidence on mHealth for disease diagnosis by health workers in SSA. In terms of geographical settings, five of the 10 includes studies were conducted in urban settings (17,(118)(119)(120)(121); three studies were conducted in semi-urban settings (1,14,117); one study was conducted in rural settings (11), and only one study was conducted in rural, semi-urban and urban settings (4). Figure 3 shows the distribution of included studies by geographical settings.…”

“…All the included studies reported on the availability of mHealth (1,4,11,14,17,(117)(118)(119)(121)(122)(123).…”

“…Kaunda-Khangamwa et al demonstrated the availability of mHealth to encourage health workers to strictly adhere to standard guidelines in the treatment of malaria, pneumonia and diarrhoea cases (17). Nelissen et al conducted a mixed method study which reported on the availability of mHealth to help hypertension patients adhere to or comply with treatment (119). Moodley et al reported evidence on the availability of mHealth for supporting patients to manage their cancer cases (123).…”

“…All the included studies reported on the use of mHealth technology for treatment support (1,4,11,14,(117)(118)(119)(121)(122)(123). Nelissen et al showed that both healthcare providers and patients perceived the mHealth app as supportive and attractive in managing patients' illness (119). Zurovac et al suggested that the text messages helped health workers to improve their quality of disease management skills (11).…”