Background

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Electronic Medication Reminders for Individuals with Hypertension Elizabeth Hotaling, RN State University of New York Institute of Technology Utica/Rome • Methods / Literature Review • An integrative research review was conducted using CINAHL, Medline, and Proquest databases. • A total of 15 studies were found, three were excluded for being in the proposal phase and two were excluded for not containing primary research • The ten remaining studies were analyzed, data was extracted and place into a table • Results • Interventions to increase medication adherence • • Interactive phone calls • • Visual messages (Short Message Services) sent to cell phones • • Text messages & text message programs (My Medication Reminder Text Messaging Program) • • Emails • • Patient education on medication adherence • • Smart phone enabled medication reminder system (mHealth device) • • Electronic medication reminder pager (Telsvar device) • • Electronic pillboxes • Analysis of Findings • Evidence regarding electronic pillboxes provided “no relationship between timed adherence and achieved blood pressure readings”. There appears to be a lacking of significant evidence based research in regards to traditional medication reminders. • There is adequate, recent evidence based research regarding different forms of electronic medication reminders. The following table reflects the advantages versus disadvantages of electronic medication reminders through an analysis of the findings. Conclusions There are multiple interventions that offer individuals with hypertension the opportunity to improve their blood pressure control. The purpose of this project was to determine if electronic medication reminders improved medication adherence in individuals with hypertension. The research provided evidence that electronic reminders such as text messages can significantly increase not only medication adherence but ultimately blood pressure control. The research also provided evidence that demonstrated no significant benefit of electronic pillboxes. Barriers to implementing this within the practice setting of medical case management include; the willingness of clients to consent to electronic reminders, and the time constraints of setting up such reminders. Nursing Implications This research has several implications to medical case manager nurses. Once clients have been identified as non-compliant with their anti-hypertensive medications, medical case managers have the opportunity to encourage and educate clients not only on the importance of medication adherence, but on the benefits of using an electronic medication reminding system. Perhaps during an assessment of a client’s medication compliance, further assessment of their willingness and ability to use electronic medication reminders should be completed. • Background • Hypertension is a serious, chronic illness that impacts millions of Americans. According to the CDC, 67 million American adults have hypertension, that is 1 in 3 adults. The CDC also reports that only approximately 47% of individuals with hypertension have it controlled. • Medication non-adherence is a major contributing factor in uncontrolled hypertension. It is estimated that improved adherence to anti-hypertensive medications could prevent 89,000 deaths in the US annually. • Medication non-adherence can be defined as non-compliance to an agreed upon treatment plan between patient and physician to take specific medications at specific frequencies. • Traditional medication reminders include; pill boxes, calendars, and human reminders. Advances in technology have led to the development of several electronic medication reminders including: emails, text messages, automatic dispensing machines, and electronic paging devices. This project planned to examine the effectiveness of electronic medication reminders • Abstract • The purpose of this project was to examine the effectiveness of electronic medication reminders for increasing medication adherence, and ultimately improved blood pressure control. The results provided evidence that electronic medication reminders can increase medication adherence to anti-hypertensive medications and significantly decrease blood pressure. This information can be used by medical case manager RNs to increase education on medication adherence and encourage the use of electronic medications reminders to clients who are identified as non-compliant with their hypertensive medications. References Center for Disease Control. (2013). High Blood Pressure Facts. Retrieved from: http://www.cdc.gov/bloodpressure/facts.htm Foreman, K., Stockl, K.M., Le, L.B., Fisk, E., Shah, S., Lew, H., Solow, B.K, Curtis, B.S. (2012). Impact of a Text Messaging Pilot Program on Patient Medication Adherence. Clinical Therapeutics, 34(5): 1084-91. Hacihasanoglu, R. & Gozum, S. (2010) The effect of patient education and home monitoring on medication compliance, hypertension management, healthy lifestyle behaviours, and BMI in a primary health care setting. Journal of Clinical Nursing, 20, 692-705. Harbig, P., Ishay, B., & Damsgaard, E.M. (2012) Suitability of an electronic reminder device for measuring drug adherence in elderly patients with complex medication. Journal Of Telemedicine & Telecare, 18(6), 352-356. doi:10.1258/jtt.2012.120120 Hood, L.J. & Leddy, S.K. (2006). Conceptual Bases of Professional Nursing. Philadelphia: Lippincott, Williams, & Wilkins. Hughes, L. D. & Done, J. (2011). Not 2 old 2 TXT: There is potential to uses email and SMS text message healthcare reminders for rheumatology patients up to 65 years old. Health Informatics Journal, 17(4) 266-276. Doi:10.1177/1460458211422019 MacKenzie, G., Ireland, S., Moore, S., Heinz, I., Johnson, R., Oczkowski, W. W., & Sahlas, D. D. (2013). Tailored interventions to improve hypertension management after stroke or TIA--Phase II (TIMSII). Canadian Journal Of Neuroscience Nursing, 35(1), 27-34. McGillicuddy, J.W., Gregoski, M.J., Weiland, A.K., Rock, R.A., Brunner-Jackson, B.M., Patel, S.K., Thomas, B.S., Taber, D.J., Chavin, K.D., Baliga, P.K., Treiber, F.A. (2013). Mobile Health Medication Adherence and Blood Pressure Control in Renal Transplant Recipients: A Proof-of-Concept Randomized Control Trial. Journal of Medical Internet Research, 2(2). Pavel, M., Jimison, H., Hayes, T., Larimer, N., Hagler, S., Vimegnon, Y., & ... Ozertem, U. (2010). Optimizing medication reminders using a decision-theoretic framework. Studies In Health Technology And Informatics, 160(Pt 2), 791-795. Pena-Robichaux, V., Kvedar, J. C., & Watson, A. J. (2010). Text Messages as a Reminder Aid and educational Tool in Adults and Adolescents with Atopic Dermatitis: A Pilot Study. Dermatology Research and Practice, 2010. Rodrigues, R., Shet, A., Antony, J., Sidney, K., Arumugam, K., Krishnamurthy, S., D’Souza, G., & Decosta, A. (2012). Supporting Adherence to Antiretroviral Therapy with Mobile phone Reminders: Results from a cohort in South India. PLoS ONE 7(8): e40723 doi:10.1371journal.pone.0040723 Zeller, A., Schroeder, K., & Peters, T.J. (2007) Electronic pillboxes (MEMS) to assess the relationship between medication adherence and blood pressure control in primary care. Scandinavian Journal of Primary Health Care, 25: 202-207. Goals 1. To determine if the existing research proves that electronic medication reminders improved medication adherence 2. To determine if medical case managers should educate clients who are currently taking daily anti-hypertensive medications on electronic medications reminders Problem-In adults with diagnosed hypertension who are taking daily doses of antihypertensive medications, who have been identified as non-compliant to medication through a nursing assessment, Intervention – does an electronic medication reminder such as a daily email, sent by a nurse case manager or care coach Comparison- when compared to traditional medication reminders such as pill boxes, calendars, and human reminders, Outcome – provide evidence that there is an increase in medication adherence to the prescribed medications, as measured by self-reported compliance. Nursing Theory Dorothea Orem’s Self-care Deficit Theory was used to guide this research. Orem’s five key concepts to this theory; self –care, self-care deficit, self-care requisites, self-care demand, and agency focus around the ideal that nurses help clients when they are unable to manage their own self-care activities. This research is aimed to provide best practices of self care education to clients. Acknowledgments This research was completed with the supervision of Cary Robertson, RN, CCM and Health Integrated care management department. Further information Please contact Elizabeth Hotaling at BethA429@msn.com for any further information.