Facilitating medication adherence and eliminating therapeutic inertia using wireless technology: proof of concept findings with uncontrolled hypertensives and kidney transplant recipients

Abstract

Effective and efficient management of chronic illness remains a significant clinical problem. To improve chronic illness management, two obstacles that must be overcome are patient non-adherence to medication regimens and provider therapeutic inertia (failure to respond in timely manner to clinical data). Using an iterative approach, behavioral theory was used to develop a mobile health (mHealth) medication and blood pressure self-management system that was patient and provider centered. Electronic medication trays provided reminder signals and smart phone text messages reminded patients to measure blood pressures using a Bluetooth-enabled monitor. Patients received mobile phone-delivered personalized motivational and reinforcement messages based upon adherence levels to these regimens. Two 3-month proof of concept randomized control trials were conducted with 2 patient groups; 1) Hispanics with uncontrolled essential hypertension (n=6), and 2) patients with hypertension after kidney transplantation. (n=6). Hispanic patients who received the mHealth intervention all exhibited significant improvements in both medication adherence and reductions in resting and 24-hour blood pressures during the trial and at 3-month follow-up, as compared to the control group. The still ongoing kidney transplant trial has shown that recipients randomized to the mHealth intervention have demonstrated significant improvements in medication adherence and reduced blood pressure two months into the trial. Following completion of both studies, patient and provider focus groups will allow further iterative refinement of the mHealth system and a feasibility trial of larger scale and longer duration.