Sustainability of Improvements in Medication Adherence through a Mobile Health Intervention

Abstract

Context-Very few patient-centered, theory-guided programs for medication adherence and blood pressure control have been conducted in kidney transplant recipients. Objective-To evaluate preliminary indications of sustainability of improved blood pressure in kidney transplant recipients 12 months after completion of a 3-month randomized controlled trial of a mobile health pilot program to improve blood pressure and medication adherence. Participants and Design-A total of 18 of the 19 trial participants were contacted and all consented to inclusion in the retrospective analysis of their medical records showing their clinic-recorded systolic blood pressures at 3, 6, and 12 months following participation in the 3-month trial of a medical regimen self-management intervention. Results-A significant group difference in systolic blood pressure was observed longitudinally, indicating that the intervention group, as compared with the standard-care group, exhibited lower clinic-measured systolic blood pressures at the 12-month posttrial follow-up visit (P= .01). At 12-month follow-up, success in establishing and sustaining control of systolic blood pressure (<131 mm Hg) was greater in the intervention group (50%) than in the control group (11%). Conclusion-Patients in the intervention group continued to exhibit lower systolic blood pressure than did patients in the control group 12 months after the trial ended, suggesting that the intervention may have a durable impact on blood pressure control that most likely reflects sustained medication adherence. These findings will aid in the development of an adequately powered randomized controlled trial to address the sustainable impact of the intervention program on medication adherence and blood pressure control.

Mobile Apps to Support the Self-Management of Hypertension: Systematic Review of Effectiveness, Usability, and User Satisfaction (Preprint)

“…The publication year of the studies ranged from 2012 to 2017 (see Table 1). Most studies (n=11) were conducted in the US [24][25][26][27][28][29][30][31][32] and Canada [33,34], while seven were carried out in European countries, including France [35], Sweden [36][37][38], Spain [39,40] and Italy [41]. The remaining three studies were conducted in China [42,43] and South Korea [44. Nine studies were randomised controlled trials (RCTs) [24,25,27,28,30,[33][34][35]42], ten were nonrandomised studies [26,29,31,32,37,[39][40][41]43,44], and two were qualitative studies [36,38].…”

“…Participants' average age ranged from 42.4 years [27] to 69.5 [42] years. The population groups of the studies included individuals with hypertension [24][25][26][27][28][29][30]32,[36][37][38][39][41][42][43][44], metabolic syndrome risk factors [34], and obstructive sleep apnoea with high cardiovascular risk [35], as well as overweight individuals [31]. Of the 21 included studies, 5 reported to have used behavioural theories, such as selfdetermination theory [24,26,27], motivational interviewing [30] and theory of planned behaviour [43] to underpin and guide the intervention methods and/or the development of the technology.…”

“…The other 11 studies mainly involved clinicians or other HCPs remotely monitoring patient data and health status [24][25][26][27][28][30][31][32][39][40][41], whilst the remaining study involved the researcher remotely monitoring patient data and alerting physicians if needed [34,36]. In these 11 studies involving HCPs, the HCPs provided feedback, including a medication plan or adjustments [24][25][26][27]39,41], regular online coaching consultation [31] instructions [28,30] or communication with patients [40,42]. …”

Feasibility of Smartphones for Real-time Assessment of Adherence Behavior and Symptom Exacerbation for High Risk Youth and Adolescents with Asthma: A Pilot Study (Preprint)

“…The redesign elements (e.g., 4 digit automated login) determined by engagement were not resource intensive but did result in a marked improvement in data accrual supporting the importance of patient engagement when designing a mHealth platform. [29][30][31] The frequent rate of data accrual combined with survey and interview data consistently conveyed ease in use of this approach. The concept of monitoring symptoms and medication use real-time in a patient's home environment could result in more timely care delivery based on current symptoms with fewer barriers to care.…”

Feasibility of Smartphones for Real-time Assessment of Adherence Behavior and Symptom Exacerbation for High Risk Youth and Adolescents with Asthma: A Pilot Study (Preprint)

“…The redesign elements (e.g., 4 digit automated login) determined by engagement were not resource intensive but did result in a marked improvement in data accrual supporting the importance of patient engagement when designing a mobile technology approach to improve care. [27][28][29] Both survey and interview data consistently conveyed ease in use of this approach for high risk patients. One parent stated, "I had no challenges, at all" "it was easy, and I'm not technology savvy."…”