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 .
Effect of a Physician Uncertainty Reduction Intervention on Blood Pressure in Uncontrolled Hypertensives—A Cluster Randomized Trial
BACKGROUND Clinical inertia , provider failure to appropriately intensify treatment , is a major contributor to uncontrolled blood pressure ( BP ) . Some clinical inertia may result from physician uncertainty over the patient ’s usual BP , adherence , or value of continuing efforts to control BP through lifestyle changes . OBJECTIVE To test the hypothesis that providing physicians with uncertainty reduction tools , including 24-h ambulatory BP monitoring , electronic bottle cap monitoring , and lifestyle assessment and counseling , will lead to improved BP control . DESIGN Cluster r and omized trial with five intervention clinics ( IC ) and five usual care clinics ( UCC ) . SETTING Six public and 4 private primary care clinics . PARTICIPANTS A total of 665 patients ( 63 percent African American ) with uncontrolled hypertension ( BP ≥140 mmHg/90 mmHg or ≥130/80 mmHg if diabetic ) . INTERVENTIONS An order form for uncertainty reduction tools was placed in the IC participants ’ charts before each visit and results fed back to the provider . OUTCOME MEASURES Percent with controlled BP at last visit . Secondary outcome was BP changes from baseline . RESULTS Median follow-up time was 24 months . IC physicians intensified treatment in 81 % of IC patients compared to 67 % in UCC ( p < 0.001 ) ; 35.0 % of IC patients and 31.9 % of UCC patients achieved control at the last recorded visit ( p > 0.05 ) . Multi-level mixed effects longitudinal regression modeling of SBP and DBP indicated a significant , non-linear slope difference favoring IC ( p time × group interaction = 0.048 for SBP and p = 0.001 for DBP ) . The model-predicted difference attributable to intervention was −2.8 mmHg for both SBP and DBP by month 24 , and −6.5 mmHg for both SBP and DBP by month 36 . CONCLUSIONS The uncertainty reduction intervention did not achieve the pre-specified dichotomous outcome , but led to lower measured BP in IC patients
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 .