Understanding the Feasibility, Acceptability, and Efficacy of a Clinical Pharmacist-led Mobile Approach (BPTrack) to Hypertension Management: Mixed Methods Pilot Study
Open accessPublished version of a preprint
Abstract
Background: Hypertension is a prevalent and costly burden in the United States. Clinical pharmacists within care teams provide effective management of hypertension, as does home blood pressure monitoring; however, concerns about data quality and latency are widespread. One approach to close the gap between clinical pharmacist intervention and home blood pressure monitoring is the use of mobile health (mHealth) technology. Objective: We sought to investigate the feasibility, acceptability, and preliminary effectiveness of BPTrack, a clinical pharmacist-led intervention that incorporates patient- and clinician-facing apps to make electronically collected, patient-generated data available to providers in real time for hypertension management. The patient app also included customizable daily medication reminders and educational messages. Additionally, this study sought to understand barriers to adoption and areas for improvement identified by key stakeholders, so more widespread use of such interventions may be achieved. Methods: We conducted a mixed methods pilot study of BPTrack, to improve blood pressure control in patients with uncontrolled hypertension through a 12-week pre-post intervention. All patients were recruited from a primary care setting where they worked with a clinical pharmacist for hypertension management. Participants completed a baseline visit, then spent 12 weeks utilizing BPTrack before returning to the clinic for follow-up. Collected data from patient participants included surveys pre- and postintervention, clinical measures (for establishing effectiveness, with the primary outcome being a change in blood pressure and the secondary outcome being a change in medication adherence), utilization of the BPTrack app, interviews at follow-up, and chart review. We also conducted interviews with key stakeholders. Results: A total of 15 patient participants were included (13 remained through follow-up for an 86.7% retention rate) in a single group, pre-post assessment pilot study. Data supported the hypothesis that BPTrack was feasible and acceptable for use by patient and provider participants and was effective at reducing patient blood pressure. At the 12-week follow-up, patients exhibited significant reductions in both systolic blood pressure (baseline mean 137.3 mm Hg, SD 11.1 mm Hg; follow-up mean 131.0 mm Hg, SD 9.9 mm Hg; P=.02) and diastolic blood pressure (baseline mean 89.4 mm Hg, SD 7.7 mm Hg; follow-up mean 82.5 mm Hg, SD 8.2 mm Hg; P<.001). On average, patients uploaded at least one blood pressure measurement on 75% (SD 25%) of study days. No improvements in medication adherence were noted. Interview data revealed areas of improvement and refinement for the patient experience. Furthermore, stakeholders require integration into the electronic health record and a modified clinical workflow for BPTrack to be truly useful; however, both patients and stakeholders perceived benefits of BPTrack when used within the context of a clinical relationship. Conclusions: Results demonstrate that a pharmacist-led mHealth intervention promoting home blood pressure monitoring and clinical pharmacist management of hypertension can be effective at reducing blood pressure in primary care patients with uncontrolled hypertension. Our data also support the feasibility and acceptability of these types of interventions for patients and providers. Trial Registration: ClinicalTrials.gov NCT02898584; https://clinicaltrials.gov/ct2/show/NCT02898584 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.8059
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Telemonitoring increased patients' awareness of their health, leading them to make improved lifestyle changes.
“Several patients expressed that telemonitoring increased their awareness of their health and consequently they made improved lifestyle changes. [19, 20, 23, 25, 26]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [19]
The 'improved care' theme was identified in seven of nine included studies.
“The “improved care” theme was identified in seven of nine studies. [19–23, 25, 26]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [19]
While five studies identified clear benefits of telemonitoring, some healthcare professionals highlighted potential drawbacks concerning treatments.
“Whilst five studies [19, 21–23, 26] identified clear benefits of telemonitoring, some HCPs highlighted potential drawbacks concerning treatments.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [19]
Patients and healthcare professionals reported additional benefits from more individualised treatment plans resulting from telemonitoring interventions.
“Patients and HCPs reported additional benefits in having more individualised treatment plans [19, 21–23, 26] resulting from telemonitoring interventions.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [19]
Dietary alterations or improvements were a common outcome among several studies.
“Dietary alterations/improvements were a common outcome among several studies. [19, 20, 23, 25]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [19]
Patients with hypertension reported increased awareness of salt intake following high blood pressure readings.
“Similarly, patients with hypertension reported an increased awareness of salt intake [19] following high blood pressure readings.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [19]
One pharmacist described a potential danger of prescribing additional medication without frequent face-to-face follow-ups.
“One pharmacist described a potential danger of prescribing additional medication without frequent face-to-face follow-ups. [19]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [19]
The technology acceptability and feasibility theme arose in six studies and comprised three sub-themes: convenience and acceptability, technology feasibility, and barriers of rural areas.
“This theme arose in six studies [19, 22–25, 27] and comprise the following sub-themes: (1) Convenience & Acceptability; (2) Technology feasibility; and (3) Barriers of rural areas.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [19]
A physician described that self-monitoring programs needed to be very simplistic, especially for older patients.
“A physician described that self-monitoring programs needed to be “very simplistic, especially for older patients”. [19]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [19]
In three studies, participants found devices difficult to use, accentuated by generational differences, with older participants generally less confident and less able to use them.
“In three studies, [19, 23, 27] participants found devices difficult to use, which was accentuated by generational differences, with older participants generally less confident and less able to use them.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [19]
Concerns over data input error were highlighted due to patients manually typing in readings, implying that devices able to automate data transfer might be better.
“Concerns over data input error were highlighted due to patients manually typing in readings, with the implication that devices able to automate data transfer might be better. [19].”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [19]
Some patients were unhappy with having to self-monitor so often and were unsure how it would be maintained in the longer term.
“However, some patients were unhappy with having to self-monitor so often and were unsure how it would be maintained in the longer-term. [19]”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [19]
In one study, multiple participants found difficulties syncing blood pressure results to their phone, while others had no problems with the telemedicine programme.
“In one study, [19] multiple participants found difficulties in syncing blood pressure results to their phone, whilst others had “no problems with the (telemedicine) programme”.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [19]
Concerns about the telemonitoring intervention were commonly reported across two sub-themes: privacy and security of personal data, and generational differences.
“Concerns about the telemonitoring intervention were commonly reported [19, 22, 24, 25] across two sub-themes: (1) Privacy and security of personal data; and (2) Generational differences.”
From Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis (2023) · cites this paper as [19]
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- Authors
- Buis, L. R., Roberson, D. N., Kadri, R., Rockey, N. G., Plegue, M. A., Danak, S. U., Guetterman, T. C., Johnson, M. G., Choe, H. M., & Richardson, C. R.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Buis, Lorraine R
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2020-08-11
- Volume
- 22
- Issue
- 8
- Pages
- e19882
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC7448180
- OpenAlex
- W3034212911
- Cited by
- 32
- References
- 37
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 6 · 2023: 8 · 2022: 4 · 2021: 3
- FWCI
- 3.91
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Eli Lilly and Company
- University of Michigan (UL1TR000433)
- National Institutes of Health (UL1TR000433)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- antihypertensive therapy, mobile health, clinical pharmacist intervention, home blood pressure monitoring, patient-generated health data, real-time data exchange, medication adherence, medication reminders, blood pressure control, primary care, feasibility and acceptability, telemedicine, patient engagement, medication review
- MeSH terms
- Feasibility Studies, Female, Humans, Hypertension, Male, Middle Aged, Pharmacists, Pilot Projects, Surveys and Questionnaires, Treatment Outcome, Telemedicine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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