Self-management of hypertension using technology enabled interventions in primary care settings

Abstract

BACKGROUND: Self-management of hypertension by controlling Blood Pressure (BP) through technology-based interventions can effectively reduce the burden of high BP, which affects one out of every three adults in the United States. OBJECTIVE: The primary aim of this study is to explore the role of technology enabled interventions to improve or enhance self-management among individuals with hypertension. METHODS: We conducted a systematic review of the literature published between July 2008 and June 2013 on the MED-LINE database (via PubMed interface) during July 2013. The search words were "hypertension" and "primary care" in combination with each of the terms of "technology", "internet", "computer" and "cell phone". Our inclusion criteria consisted of: (a) Randomized Controlled Trials (RCTs) (b) conducted on human subjects; (c) technology-based interventions (d) to improve self-management (e) of hypertension and if the (f) final results of the study were published in the study. Our exclusion criteria included (a) management of other conditions and (b) literature reviews. RESULTS: The initial search resulted in 108 results. After applying the inclusion and exclusion criteria, a total of 12 studies were analyzed. Various technologies implemented in the studies included internet-based telemonitoring and education, telephone-based telemonitoring and education, internet-based education, telemedicine via videoconferencing, telehealth kiosks and automated modem device. Some studies also involved a physician intervention, in addition to patient intervention. The outcomes of proportion of subjects with BP control and change in mean SBP and DBP were better for the group of subjects who received combined physician and patient interventions. CONCLUSION: Interventions to improve BP control for self-management of hypertension should be aimed at both physicians as well as the patients. More interventions should utilize the JNC-7 guidelines and cost-effectiveness of the intervention should also be assessed.

Supporting self-management for people with hypertension

“… Monitoring of blood pressure with feedback was a feature of self-management support in 17 out of 29 reviews, though the monitoring process varied. Home BP monitoring [28,31,35,36,42,46,48,50], was often mediated by telehealth [27,29,32,34,37,41,43,52,53], and in some reviews also included monitoring of medication intake, weight, physical activity and smoking [40,52]. The impact of monitoring on blood pressure control varied, with evidence that monitoring associated with feedback from healthcare professionals (including via telehealth) or as part of a complex intervention to promote medication adherence was more likely to be effective than self-monitoring as an unsupported…”

“…Regular clinical review  Symptoms are commonly reported and should be acknowledged 21,23,26 9 reviews included regular clinical reviews 37,39,40,42,43,46,49,52,53 A5. Monitoring of condition with feedback  Interventions like self-monitoring of BP (HBPM) can foster therapeutic alliance 22 and promote a more internal locus of control 18 reviews included HBPM [27][28][29]31,32,[34][35][36][37][41][42][43]46,48,50,52,53,56 with evidence that feedback (e.g. via telehealth) improved effectiveness 27,29,32,34,37,41,43,52,53,56 A6.…”

“…Monitoring of condition with feedback  Interventions like self-monitoring of BP (HBPM) can foster therapeutic alliance 22 and promote a more internal locus of control 18 reviews included HBPM [27][28][29]31,32,[34][35][36][37][41][42][43]46,48,50,52,53,56 with evidence that feedback (e.g. via telehealth) improved effectiveness 27,29,32,34,37,41,43,52,53,56 A6. Practical support with adherence (medication or behavioural)  Adherence, particularly to medication, may be affected by factors including symptom guided use and fear of dependence rather than simply forgetting to take medication 23,24 .…”

“…19 interventions provided HBPM equipment [27][28][29]31,32,[34][35][36][37][41][42][43]46,48,50,52,53,56,57 A8. Provision of easy access to advice or support when needed Telehealth was described as a strategy for providing access to support 22 6 interventions explicitly enhanced access to support 27,29,34,38,42,50 A9.…”

Hypertension in Blacks

“…73 The inclusion of technology-based or mobile health (mHealth) interventions 74, 75 should be considered to test whether they can enhance culturally-appropriate community-based programs. This can include telephone-delivered hypertension management programs 76, 77 in conjunction with HBPM, or ABPM and/or mobile phone text messaging to support medication adherence. 78, 79 Smartphone technology can also be used to facilitate data collection, including ecological momentary assessments among JHS participants between study visits and deliver or re-emphasize healthcare education 80 and lifestyle interventions.…”