The most commonly described determinants at the patient level were lack of education , lack of self-awareness , lack of self-efficacy , and forgetfulness .
Clinical inertia and an inadequate health workforce were the most commonly targeted determinants at the health care team and system level .
Taking medication , interactive patient-provider communication , self-measurement , and lifestyle management were the most cited patient behaviors at both levels .
Most of the DIs did not include support from peers or family members , despite its reported effectiveness and the rate of social media penetration .
Background Information on how behavior change strategies have been used to design digital interventions ( DIs ) to improve blood pressure ( BP ) control or medication adherence ( MA ) for patients with hypertension is currently limited .
Objective Hypertension is a major modifiable risk factor for cardiovascular diseases and can be controlled with appropriate medication .
Many interventions that target MA to improve BP are increasingly using modern digital technologies .
This systematic review was conducted to discover how DIs have been design ed to improve MA and BP control among patients with hypertension in the recent 10 years .
Effectiveness of Digital Medicines to Improve Clinical Outcomes in Patients with Uncontrolled Hypertension and Type 2 Diabetes: Prospective, Open-Label, Cluster-Randomized Pilot Clinical Trial
Background Hypertension and type 2 diabetes mellitus are major modifiable risk factors for cardiac , cerebrovascular , and kidney diseases . Reasons for poor disease control include nonadherence , lack of patient engagement , and therapeutic inertia . Objective The aim of this study was to assess the impact on clinic-measured blood pressure ( BP ) and glycated hemoglobin ( HbA1c ) using a digital medicine offering ( DMO ) that measures medication ingestion adherence , physical activity , and rest using digital medicines ( medication taken with ingestible sensor ) , wearable sensor patches , and a mobile device app . Methods Participants with elevated systolic BP ( SBP ≥140 mm Hg ) and HbA1c ( ≥7 % ) failing antihypertensive ( ≥2 medications ) and oral diabetes therapy were enrolled in this three-arm , 12-week , cluster-r and omized study . Participants used DMO ( includes digital medicines , the wearable sensor patch , and the mobile device app ) for 4 or 12 weeks or received usual care based on site r and omization . Providers in the DMO arms could review the DMO data via a Web portal . In all three arms , providers were instructed to make medical decisions ( medication titration , adherence counseling , education , and lifestyle coaching ) on all available clinical information at each visit . Primary outcome was change in SBP at week 4 . Other outcomes included change in SBP and HbA1c at week 12 , and low-density lipoprotein cholesterol ( LDL-C ) and diastolic blood pressure ( DBP ) at weeks 4 and 12 , as well as proportion of patients at BP goal ( < 140/90 mm Hg ) at weeks 4 and 12 , medical decisions , and medication adherence patterns . Results Final analysis included 109 participants ( 12 sites ; age : mean 58.7 , SD years ; female : 49.5 % , 54/109 ; Hispanic : 45.9 % , 50/109 ; income ≤ US $ 20,000 : 56.9 % , 62/109 ; and ≤ high school education : 52.3 % , 57/109 ) . The DMO groups had 80 participants ( 7 sites ) and usual care had 29 participants ( 5 sites ) . At week 4 , DMO result ed in a statistically greater SBP reduction than usual care ( mean –21.8 , SE 1.5 mm Hg vs mean –12.7 , SE 2.8 mmHg ; mean difference –9.1 , 95 % CI –14.0 to –3.3 mm Hg ) and maintained a greater reduction at week 12 . The DMO groups had greater reductions in HbA1c , DBP , and LDL-C , and a greater proportion of participants at BP goal at weeks 4 and 12 compared with usual care . The DMO groups also received more therapeutic interventions than usual care  . Medication adherence was ≥80 % while using the DMO . The most common adverse event was a self-limited rash at the wearable sensor site ( 12 % , 10/82 ) . Conclusions For patients failing hypertension and diabetes oral therapy , this DMO , which provides dose-by-dose feedback on medication ingestion adherence , can help lower BP , HbA1c , and LDL-C , and promote patient engagement and provider decision making . Trial Registration Clinical trials.gov NCT02827630 ; https:// clinical trials.gov/show/NCT02827630 ( Archived by WebCite at http://www.webcitation.org/6rL8dW2VF
The most commonly described determinants at the patient level were lack of education , lack of self-awareness , lack of self-efficacy , and forgetfulness .
Clinical inertia and an inadequate health workforce were the most commonly targeted determinants at the health care team and system level .
Taking medication , interactive patient-provider communication , self-measurement , and lifestyle management were the most cited patient behaviors at both levels .
Most of the DIs did not include support from peers or family members , despite its reported effectiveness and the rate of social media penetration .
Background Information on how behavior change strategies have been used to design digital interventions ( DIs ) to improve blood pressure ( BP ) control or medication adherence ( MA ) for patients with hypertension is currently limited .
Objective Hypertension is a major modifiable risk factor for cardiovascular diseases and can be controlled with appropriate medication .
Many interventions that target MA to improve BP are increasingly using modern digital technologies .
This systematic review was conducted to discover how DIs have been design ed to improve MA and BP control among patients with hypertension in the recent 10 years .