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Development and Preliminary Feasibility of an Automated Hypertension Self-Management System - 27/09/18

Doi : 10.1016/j.amjmed.2018.04.038 
Taya Irizarry, PhD a, Matthew Allen, BS b, Brian P. Suffoletto, MD c, Julian Einhorn, BS d, Lora E. Burke, PhD MPH e, f, Thomas W. Kamarck, PhD d, Bruce L. Rollman, MD, MPH g, h, Matthew F. Muldoon, MD, MPH i, j,
a Department of Psychiatry, University of Pittsburgh School of Medicine, Pa 
b University of Pittsburgh School of Medicine, Pa 
c Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pa 
d Department of Psychology, University of Pittsburgh School of Arts and Sciences, Pa 
e Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pa 
f Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pa 
g Division of General Internal Medicine 
h Center for Behavioral Health and Smart Technology 
i Division of Cardiology, University of Pittsburgh School of Medicine, Pa 
j Heart and Vascular Institute Hypertension Center, UPMC Health System, Pittsburgh, Pa 

Requests for reprints should be addressed to Matthew F. Muldoon, MD, MPH, Heart and Vascular Institute Hypertension Center, UPMC Health System, Old Engineering Hall, Room 506, University of Pittsburgh, Pittsburgh, PA 15213.Heart and Vascular Institute Hypertension CenterUPMC Health System, Old Engineering Hall, Room 506PittsburghPA 15213Pittsburgh

Abstract

Background

Uncontrolled hypertension constitutes a significant challenge throughout the world. Blood pressure measurement by patients is informative for both patients and providers but is rarely performed systematically, thereby reducing its utility. Mobile phones can be used to efficiently prompt individuals to measure blood pressure and automate data management while avoiding technology barriers to widespread adoption. Presented is the design and pilot test results of MyBP, an automated texting intervention to support blood pressure self-monitoring and patient self-management.

Methods

Three sequential phases are described: (1) stakeholders’ needs assessment, (2) preliminary design pilot (n = 10), and (3) a 6-week pilot of the redesigned comprehensive program with hypertensive patients (n = 43) recruited from 3 clinical sites (Emergency Department, Primary Care, Hypertension Center). Outcomes of interest included participant adherence, perceived importance of blood pressure monitoring, and healthy behavior change.

Results

Median adherence to MyBP prompts over 6 weeks was 79% (72% emergency department, 84% primary care, and 96% hypertension center, H[2] = 5.56, P = .06). Adherence did not vary by age, sex, education, or baseline use of texting but was lowest among patients recruited from the emergency department (χ[2]2 = 6.66, P = .04). In the exit survey, MyBP was associated with increased importance of blood pressure self-monitoring and particularly motivated primary care and emergency department groups to improve dietary habits, increase daily physical activity, and focus on stress reduction. The majority of participants (88%) indicated interest in using the program for 6 months.

Conclusions

Automated mobile-phone–based blood pressure self-monitoring using MyBP is feasible, acceptable, and scalable, and may improve self-management and support clinical care.

El texto completo de este artículo está disponible en PDF.

Keywords : eHealth, Hypertension, Home blood pressure measurement, Self-management, Text messaging


Esquema


 Funding: The University of Pittsburgh Physicians Academic Foundation provided seed funding.
 Conflict of Interest: None.
 Authorship: Authors TI, MA, JE, and MFM were involved in the direct data analysis. All authors were involved in conceptualization of the MyBP program and directly contributed to writing and iteratively revising the manuscript.


© 2018  Publicado por Elsevier Masson SAS.
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Vol 131 - N° 9

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