Medication adherence and activity patterns underlying uncontrolled hypertension: Assessment and recommendations by practicing pharmacists using digital health care

OBJECTIVES: This report summarizes the first use of a digital health feedback system (DHFS) by practicing pharmacists to establish evidence-based blood pressure (BP) management recommendations. SETTING: Fifteen commercial pharmacies and 39 patients in the Isle of Wight participated. PRACTICE DESCRIPTION: The pharmacists were experienced in providing New Medicine Services to patients in their communities. PRACTICE INNOVATION: The pharmacists utilized a commercially available DHFS. The DHFS utilized FDA-cleared and CE-marked class 2 medical devices passively captured and shared information about medication-taking using an ingestible sensor, and daily patterns of rest, activity, and exercise using a wearable patch that incorporates an accelerometer. INTERVENTIONS: Pharmacists provided targeted counselling for BP management as guided by the digital information. EVALUATION: Blood pressure was measured serially, and patient and provider experiences with DHFS use were assessed using satisfaction surveys. RESULTS: The mean change in SBP over the 2-week evaluation period was -7.9 ± 22.1; mean change in DBP was -2.8 ± 12.9. A root cause for persistent hypertension was determined for all of these 34 patients: 68% had pharmaceutical resistance, and 32% had inadequate medication use. Specifically, 29% were found to be capable to achieving blood pressure control on their currently prescribed medications, 68% were found to have a need for additional pharmacological treatment, and 3% needed additional adherence support. Pharmacists found that the DHFD helped in targeting specific recommendations, and to create a collaborative experience with their patients. Patients found the experience to be positive and helpful. CONCLUSION: DHFS that provides confirmation of medication taking and objective measures of lifestyle patterns can help pharmacists to identify specific factors contributing to uncontrolled hypertension, to make evidence-based prescribing and lifestyle recommendations for achieving treatment goals, and to create a collaborative experience for patients in the management of their self-care.