Smartphone apps for managing hypertension: what do patients and providers want?

By Dr. Eimear Morrissey, National University of Ireland, Galway

Hypertension (or high blood pressure) is a chronic condition in which the blood vessels have persistently raised pressure. It is one of the leading risk factors for heart attack and stroke and is one of the most common chronic conditions seen today. It is estimated that hypertension affects at least one billion people worldwide. However, it is not all bad news, as pharmaceutical treatment for hypertension is very effective and can reduce the risk of coronary events and stroke by up to 50%. Unfortunately, despite their effectiveness, there is a substantial lack of adherence to anti-hypertensive medications. For a variety of reasons people are really bad at taking anti-hypertensive medication. So what can we do to help?

There have been successful interventions to help people adhere to their anti-hypertensive medications in the past. These have often involved action planning and self-monitoring of blood pressure. However, face to face interventions are often costly and difficult to scale up. A digital intervention seems like a natural solution to this, as both action planning and self-monitoring of blood pressure can be easily hosted on a digital device. Accordingly, there are lots of apps and websites available to help people manage their hypertension and adherence to anti-hypertensive medication. A typical smartphone app for the self-management of hypertension contains a reminder function (where the person can input the time they would like to take their medication and then be reminded) and a home blood pressure monitoring function (where the patient has a home BP monitor which is connected to the app via Bluetooth). But what do people living with hypertension and their doctors think and feel about these types of digital interventions?

Two studies of my PhD research examined this. The majority of hypertension care in Ireland (as in the UK) occurs in primary care. We conducted a qualitative interview study with 10 general practitioners (GPs) and investigated their thoughts and feelings about using this kind of technology with people with hypertension in their practice. We also conducted a qualitative focus group study with twenty four people with hypertension where we asked them their views on using this kind of technology to manage their condition. The participants also interacted with a typical smartphone app for hypertension management.  We (a multidisciplinary team – two health psychologists, a GP, a nurse and a PhD candidate) conducted thematic analysis on both sets of data.

Interestingly, similar themes were generated from the data. Both GPs and patients felt that this type of app could empower them. The GPs liked the idea of getting accurate blood pressure data over time (blood pressure values measured in the clinic are notoriously unreliable) and patients felt better equipped to talk to their GP about their blood pressure when they had tracked it and could visualise it themselves. Both also expressed concerns about the extra BP data though – GPs were fearful of anything that could increase their workload and some patients were worried that over engagement with the app could lead to health related anxiety. As people with hypertension tend to be an older cohort, both groups felt that this type of technology may not have realised its full potential at the moment, but felt that future generations would undoubtedly be very engaged with it. Finally, both groups made suggestions about how this type of technology could be improved – GPs wanted stringent data protection in place and patients liked the idea of also being able to store medical and pharmaceutical information on the app in case of a medical emergency.

You can read both of these studies in more detail here and here.

Questions:

• Is there a place for digital interventions in increasing adherence to medications?
• Should patient generated data be incorporated into primary care? What are the opportunities and challenges with this?

Bio:

Eimear Morrissey (@EimearMorrissey) recently completed her PhD at the National University of Ireland, Galway. Her PhD research focused on developing the evidence base for a digital intervention to enhance adherence to medication in people with hypertension, and was supervised by Dr. Gerry Molloy and Dr. Jane Walsh. She is currently working as a postdoctoral researcher on the Irish Research Council funded project “Comparing the effectiveness of behaviour change interventions versus new medical treatments: Movement and medicine?” Eimear also serves as treasurer for CREATE – the European Health Psychology Society’s early career network.

eimear.morrissey@nuigalway.ie