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 .
An Electronic Adherence Measurement Intervention to Reduce Clinical Inertia in the Treatment of Uncontrolled Hypertension: The MATCH Cluster Randomized Clinical Trial
ABSTRACT BACKGROUND To appropriately manage uncontrolled hypertension , clinicians must decide whether blood pressure ( BP ) is above goal due to a need for additional medication or to medication nonadherence . Yet , clinicians are poor judges of adherence , and uncertainty about adherence may promote inertia with respect to medication modification . OBJECTIVE We aim ed to determine the effect of sharing electronically-measured adherence data with clinicians on the management of uncontrolled hypertension . DESIGN This was a cluster r and omized trial . PARTICIPANTS Twenty-four primary care providers ( 12 intervention , 12 usual care ; cluster units ) and 100 patients with uncontrolled hypertension ( 65 intervention , 35 usual care ) were included in the study . INTERVENTIONS At one visit per patient , clinicians in the intervention group received a report summarizing electronically measured adherence to the BP regimen and recommended clinical actions . Clinicians in the control group did not receive a report . MAIN MEASURES The primary outcome was the proportion of visits with appropriate clinical management ( i.e. , treatment intensification among adherent patients and adherence counseling among nonadherent patients ) . Secondary outcomes included patient-rated quality of care and communication during the visit . KEY RESULTS The proportion of visits with appropriate clinical management was higher in the intervention group than the control group ( 45 out of 65 ; 69 % ) versus ( 12 out of 35 ; 34 % ; p = 0.001 ) . A higher proportion of adherent patients in the intervention group had their regimen intensified ( p = 0.01 ) , and a higher proportion of nonadherent patients in the intervention group received adherence counseling ( p = 0.005 ) . Patients in the intervention group were more likely to give their clinician high ratings on quality of care ( p = 0.05 ) , and on measures of patient-centered ( p = 0.001 ) and collaborative communication ( p = 0.02 ) . CONCLUSIONS Providing clinicians with electronically-measured antihypertensive adherence reports reduces inertia in the management of uncontrolled hypertension . Trial Registration NCT01257347 ; http:// clinical
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 .