Specific hypertension smartphone application to improve medication adherence in hypertension: a cluster-randomized trial.

Introduction: Digital interventions, such as smartphone applications (apps), are becoming an increasingly common way to support medication adherence and self-management in chronic illness.Aim: To evaluate the effectiveness of the intervention in pharmacological therapeutic adherence in mild to moderate arterial hypertension (AHT), through an app installed on a mobile phone, as well as the degree of control reached by the patient with this tool.Methods: Prospective, randomized controlled trial, full study and multicenter study. Four primary care centers participated. One hundred and fifty-four hypertensive patients under antihypertensive treatment were included. Two groups were established: a control group (CG) with usual intervention (n = 77) and an intervention group (n = 77) (IG), targeting hypertensive people who owned and regularly used a mobile smartphone, specifically using the app called AlerHTA to promote health education and reminder of appointments. There were three visits: initial, 6 and 12 months. Drug adherence was measured by electronic monitors (MEMSs). The primary outcomes were average daily percentage adherence between 80 and 100%, and AHT control.Results: A total of 148 patients finished the study. Mean age was 57.5 ± 9.9. Global adherence was 77.02% (CI = 70.25-83.79) and daily adherence was 74.32% (CI = 67.29-81.35%). Daily adherence was 93.15% and 86.3% in IG, and 70.66% and 62.66% in CG after 6 and 12 months respectively (p < .05). The percentage of uncontrolled patients was 28.3% (CI = 21.05-35.55%). The control of high blood pressure at 12 months was 17.8% and 38.6% for IG and CG respectively (p < .05). The number of patients needed to treat to avoid non-adherence (NNT) was 4.23 patients.Conclusions: The intervention with an app installed on the mobile phones of hypertensive patients favors pharmacological therapeutic adherence and improves the percentage of hypertensive patient control.Trial registration: Spanish Agency of Medicine: EPA-SP UN-HTA-2015-01.

Validation of the electronic prescription as a method for measuring treatment adherence in hypertension.

OBJECTIVE: To validate electronic prescriptions (e-prescriptions) as a method for measuring treatment adherence in patients with hypertension. METHODS: This prospective study initially included 120 patients treated for hypertension in primary care centers. Adherence was measured using the gold standard, the medication event monitoring system (MEMS), versus the index test, the e-prescription program, at baseline and at 6, 12, 18 and 24 months. We calculated the adherence rate using the MEMS and the medication possession ratio (MPR) for the e-prescriptions. We considered patients adherent if they had an adherence rate of 80% to 100%. To validate the e-prescription, we obtained measures of diagnostic accuracy, the Kappa concordance index, and the area under the ROC curve (AUC). RESULTS: We included 102 patients. Overall adherence was 77.4% by MEMS (95%CI: 66.8-88) and 80.4% (95%CI: 70.3-90.5) by MPR. At 24 months, sensitivity was 87% and specificity, 93.7%. The AUC was 0.903 (95%CI: 0.817-0.989). CONCLUSION: Measures of treatment adherence were not significantly different between e-prescription and gold standard at most visits, and the e-prescription showed good discriminatory diagnostic capacity. PRACTICE IMPLICATIONS: If patients are included in an e-prescription program for at least 2 years, e-prescription is an inexpensive method to measure adherence in hypertension.

[Influence of the patient's companion on the discussion and length of the clinical interview in primary health care]. / Influencia del acompañante en la negociación y la duración de la consulta en atención primaria.

OBJECTIVE: To find out the percentage of patients who come accompanied to their medical appointments, their companion's profile and his/her influence on the discussion and the length of the clinical interview in Primary Health Care. DESIGN: Descriptive observational study. SETTING: Adoratrices and La Orden Healthcare Centers. Health District: Huelva-Coast. PARTICIPANTS: Non-probabilistic randomized sample of 390 interviews in November 2007. MAIN MEASUREMENTS: Data was collected by 4 external observers on: the companion and his/her characteristics, length of clinical interview, the interview strategies employed, success and differences when with a companion. RESULTS: The companion was present in 30.5% of the clinical interviews (95% CI, 25.9%-35.3%). The typical companion is female (61.3%), 52 years old, wife and co-worker. Strategies were used in 6.7% of interviews (95% CI, 2.8%-15.6%), the most frequent being signalling. The difference as regards initial exposure without interruption was 2s without and with a companion (p=0.276). The interview finished with a difference of 46 s without companion and with companion (p=0.098). As regards the length of the clinical interview, without discussion it was 7 min long and with discussion 8 min and 38 s (p=0.034). There was discussion in 16.4% of the interviews (95% CI, 12.9%-20.5%) and there was agreement in 88.9% (95% CI, 78.4%-95.4%). The most frequent strategy was that of redirecting objectives. CONCLUSIONS: Approximately one third of the patients came accompanied. The most frequent profile was the co-worker. The companion does not have an effect on the length of the interview. Length increases when there is discussion.