title: Home and Online Management and Evaluation of Blood Pressure (HOME BP) digital intervention for self-management of uncontrolled, essential hypertension: a protocol for the randomised controlled HOME BP trial Cloud-based BP system integrated with CPOE improves self-management of the hypertensive patients: A randomized controlled trial A practice-based randomized controlled trial to improve medication adherence among Latinos with hypertension: study protocol for a randomized controlled trial Designing an Internet-Based Multidomain Intervention for the Prevention of Cardiovascular Disease and Cognitive Impairment in Older Adults: The HATICE Trial. Comparing the effects of education using telephone follow-up and smartphone-based social networking follow-up on self-management behaviors among patients with hypertension Effectiveness of Digital Medicines to Improve Clinical Outcomes in Patients with Uncontrolled Hypertension and Type 2 Diabetes: Prospective, Open-Label, Cluster-Randomized Pilot Clinical Trial Are you more concerned about or relieved by medicines? An explorative randomized study of the impact of telephone counseling by pharmacists on patients' beliefs regarding medicines and blood pressure control. A coordinated PCP-Cardiologist Telemedicine Model (PCTM) in China’s community hypertension care: study protocol for a randomized controlled trial Effects of a Web-Based Patient Activation Intervention to Overcome Clinical Inertia on Blood Pressure Control: Cluster Randomized Controlled Trial Sustainability of Improvements in Medication Adherence through a Mobile Health Intervention Evaluating a web-based self-management program for employees with hypertension and prehypertension: a randomized clinical trial. Effectiveness of a quality improvement intervention targeting cardiovascular risk factors: are patients responsive to information and encouragement by mail or post? A randomised controlled trial of a consumer-focused e-health strategy for cardiovascular risk management in primary care: the Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) study protocol Efficacy of a text messaging (SMS) based intervention for adults with hypertension: protocol for the StAR (SMS Text-message Adherence suppoRt trial) randomised controlled trial The Influence of Wireless Self-Monitoring Program on the Relationship Between Patient Activation and Health Behaviors, Medication Adherence, and Blood Pressure Levels in Hypertensive Patients: A Substudy of a Randomized Controlled Trial Home blood pressure monitoring, secure electronic messaging and medication intensification for improving hypertension control: a mediation analysis. Feasibility of treating prehypertension with an angiotensin-receptor blocker. Rationale and design of the Medication adherence Improvement Support App For Engagement-Blood Pressure (MedISAFE-BP) trial. The effectiveness of daily SMS reminders in pharmaceutical care of older adults on improving patients’ adherence to antihypertensive medication (SPPA): study protocol for a randomized controlled trial EHR‐Based Medication Support and Nurse‐Led Medication Therapy Management: Rationale and Design for a Three‐Arm Clinic Randomized Trial Comparing the effectiveness of the BPMAP (Blood Pressure Management Application) and usual care in self-management of primary hypertension and adherence to treatment in patients aged 30–60 years: study protocol for a randomized controlled trial Mobilizing Your Medications: An Automated Medication Reminder Application for Mobile Phones and Hypertension Medication Adherence in a High-Risk Urban Population Intrapersonal, social and physical environmental determinants of moderate-to-vigorous physical activity in working-age women: a systematic review protocol Hypertension management using mobile technology and home blood pressure monitoring: results of a randomized trial in two low/middle-income countries. Rationale and design of the Study of a Tele-pharmacy Intervention for Chronic diseases to Improve Treatment adherence (STIC2IT): A cluster-randomized pragmatic trial. Feasibility and Preliminary Outcomes of a Web and Smartphone–Based Medication Self-Management Platform for Chronically Ill Patients Telemedicine cardiovascular risk reduction in veterans: The CITIES trial Electronic communications and home blood pressure monitoring (e-BP) study: design, delivery, and evaluation framework. Effect of a Physician Uncertainty Reduction Intervention on Blood Pressure in Uncontrolled Hypertensives—A Cluster Randomized Trial An Electronic Adherence Measurement Intervention to Reduce Clinical Inertia in the Treatment of Uncontrolled Hypertension: The MATCH Cluster Randomized Clinical Trial A pilot-study to identify the feasibility of an Internet-based coaching programme for changing the vascular risk profile of high-risk patients. Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country. A Ubiquitous Chronic Disease Care system using cellular phones and the internet. A randomized controlled trial of positive-affect intervention and medication adherence in hypertensive African Americans. Low-health literacy flashcards & mobile video reinforcement to improve medication adherence in patients on oral diabetes, heart failure, and hypertension medications. Protocol for the mWellcare trial: a multicentre, cluster randomised, 12-month, controlled trial to compare the effectiveness of mWellcare, an mHealth system for an integrated management of patients with hypertension and diabetes, versus enhanced usual care in India Reducing clinical inertia in hypertension treatment: a pragmatic randomized controlled trial. Mobile phone text messaging improves antihypertensive drug adherence in the community. Tablet-Aided BehavioraL intervention EffecT on Self-management skills (TABLETS) for Diabetes Chronic disease management: what will it take to improve care for chronic illness? Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. Telehealth for patients at high risk of cardiovascular disease: pragmatic randomised controlled trial Reinforcing adherence to antihypertensive medications. A multifactorial intervention to improve blood pressure control in co-existing diabetes and kidney disease: a feasibility randomized controlled trial. Development of mWellcare: an mHealth intervention for integrated management of hypertension and diabetes in low-resource settings Economic evaluation of home blood pressure monitoring with or without telephonic behavioral self-management in patients with hypertension. Efficacy of a nurse-led email reminder program for cardiovascular prevention risk reduction in hypertensive patients: a randomized controlled trial. Technical and compliance considerations for mobile health self-monitoring of glucose and blood pressure for patients with diabetes The impact of a patient web communication intervention on reaching treatment suggested guidelines for chronic diseases: A randomized controlled trial.
abstract: Introduction Self-management of hypertension , including self-monitoring and antihypertensive medication titration , lowers blood pressure ( BP ) at 1 year compared to usual care . The aim of the current trial is to assess the effectiveness of the Home and Online Management and Evaluation of Blood Pressure ( HOME BP ) intervention for the self-management of hypertension in primary care . Methods and analysis The HOME BP trial will be a r and omised controlled trial comparing BP self-management — consisting of the HOME BP online digital intervention with self-monitoring , lifestyle advice and antihypertensive drug titration — with usual care for people with uncontrolled essential hypertension . Eligible patients will be recruited from primary care and r and omised to usual care or to self-management using HOME BP . The primary outcome will be the difference in mean systolic BP ( mm Hg ) at 12-month follow-up between the intervention and control groups adjusting for baseline BP and covariates . Secondary outcomes ( also adjusted for baseline and covariates where appropriate ) will be differences in mean BP at 6 months and diastolic BP at 12 months ; patient enablement ; quality of life , and economic analyses including all key re sources associated with the intervention and related services , adopting a broad societal perspective to include NHS , social care and patient costs , considered within trial and modelled with a lifetime horizon . Medication beliefs , adherence and changes ; self-efficacy ; perceived side effects and lifestyle changes will be measured for process analyses . Qualitative analyses will explore patient and healthcare professional experiences of HOME BP to gain insights into the factors affecting acceptability , feasibility and adherence . Ethics and dissemination This study has received NHS ethical approval ( REC reference 15/SC/0082 ) . The findings from HOME BP will be disseminated widely through peer- review ed publications , scientific conferences and workshops . If successful , HOME BP will be directly applicable to UK primary care management of hypertension . Trial registration number IS RCT N13790648 ; pre- results BACKGROUND Less than 50 % of patients with hypertensive disease manage to maintain their blood pressure ( BP ) within normal levels . OBJECTIVE The aim of this study is to evaluate whether cloud BP system integrated with computerized physician order entry ( CPOE ) can improve BP management as compared with traditional care . METHODS A r and omized controlled trial done on a r and om sample of 382 adults recruited from 786 patients who had been diagnosed with hypertension and receiving treatment for hypertension in two district hospitals in the north of Taiwan . Physicians had access to cloud BP data from CPOE . Neither patients nor physicians were blinded to group assignment . The study was conducted over a period of seven months . RESULTS At baseline , the enrollees were 50 % male with a mean ( SD ) age of 58.18 ( 10.83 ) years . The mean sitting BP of both arms was no different . The proportion of patients with BP control at two , four and six months was significantly greater in the intervention group than in the control group . The average capture rates of blood pressure in the intervention group were also significantly higher than the control group in all three check-points . CONCLUSIONS Cloud-based BP system integrated with CPOE at the point of care achieved better BP control compared to traditional care . This system does not require any technical skills and is therefore suitable for every age group . The praise and assurance to the patients from the physicians after review ing the Cloud BP records positively reinforced both BP measuring and medication adherence behaviors Background Latinos experience disproportionately higher rates of uncontrolled hypertension as compared to Blacks and Whites . While poor adherence is a major contributor to disparities in blood pressure control , data in Latino patients are scant . More importantly , translation of interventions to improve medication adherence in community-based primary care practice s , where the majority of Latino patients receive their care is non-existent . Methods Using a r and omized controlled design , this study evaluates the effectiveness of a culturally tailored , practice -based intervention compared to usual care on medication adherence , among 148 Latino patients with uncontrolled hypertension who are non-adherent to their antihypertensive medications .  Bilingual medical assistants trained as Health Coaches deliver the intervention using an electronic medical record system-embedded adherence script . Patients r and omized to the intervention group receive patient-centered counseling with a Health Coach to develop individualized self-monitoring strategies to overcome barriers and improve adherence behaviors . Health Coach sessions are held biweekly for the first 3 months ( 6 sessions total ) and then monthly for the remaining 3 months ( 3 sessions total ) . Patients r and omized to the usual care group receive st and ard hypertension treatment recommendations as determined by their primary care providers . The primary outcome is the rate of medication adherence at 6 months . The secondary outcome is reduction in systolic and diastolic blood pressure at 6 months . Discussion If successful , findings from this study will provide salient information on the translation of culturallytailored , evidence -based interventions targeted at medication adherence and blood pressure control into practice -based setting s for this high-risk population .Trial registration NCT01643473 on 16 July 2012 BACKGROUND Many dementia and cardiovascular disease ( CVD ) cases in older adults are attributable to modifiable vascular and lifestyle-related risk factors , providing opportunities for prevention . In the Healthy Aging Through Internet Counselling in the Elderly ( HATICE ) r and omized controlled trial , an internet-based multidomain intervention is being tested to improve the cardiovascular risk ( CVR ) profile of older adults . OBJECTIVE To design a multidomain intervention to improve CVR  , based on the guidelines for CVR management , and administered through a coach-supported , interactive , platform to over 2500 community-dwellers aged 65 + in three European countries . METHODS A comparative analysis of national and European guidelines for primary and secondary CVD prevention was performed . Results were used to define the content of the intervention . RESULTS The intervention design focused on promoting awareness and self-management of hypertension , dyslipidemia , diabetes mellitus , and overweight , and supporting smoking cessation , physical activity , and healthy diet . Overall , available guidelines lacked specific recommendations for CVR management in older adults . The comparative analysis of the guidelines showed general consistency for lifestyle-related recommendations . Key differences , identified mostly in methods used to assess the overall CVR , did not hamper the intervention design . Minor country-specific adaptations were implemented to maximize the intervention feasibility in each country . CONCLUSION Despite differences in CVR management within the countries considered , it was possible to design and implement the HATICE multidomain intervention . The study can help define preventative strategies for dementia and CVD that are applicable internationally Background : Little is known about the benefits of social networks in the management of patients . Objective : The aim of this study was to compare the effects of self-management ( SM ) education using telephone follow-up and mobile phone-based social networking on SM behaviors among patients with hypertension . Methods : This r and omized clinical trial was conducted with 100 patients . They were r and omly allocated to four groups : ( i ) control , ( ii ) SM training without follow-up , ( iii ) telephone follow-up and ( iv ) smartphone-based social networking follow-up . The hypertension SM behavior question naire was used for data collection before and six weeks after the study . Results : Those patients who underwent SM education training ( with and without follow-up ) had statistically significant differences from those in the control group in terms of SM behaviors ( p < .001 ) . There was no statistically significant difference between different types of follow-up . Conclusion : SM education using telephone follow-up and /or smartphone-based social networking follow-up influenced SM behaviors among patients with hypertension Background Hypertension and type 2 diabetes mellitus are major modifiable risk factors for cardiac , cerebrovascular , and kidney diseases . Reasons for poor disease control include nonadherence , lack of patient engagement , and therapeutic inertia . Objective The aim of this study was to assess the impact on clinic-measured blood pressure ( BP ) and glycated hemoglobin ( HbA1c ) using a digital medicine offering ( DMO ) that measures medication ingestion adherence , physical activity , and rest using digital medicines ( medication taken with ingestible sensor ) , wearable sensor patches , and a mobile device app . Methods Participants with elevated systolic BP ( SBP ≥140 mm Hg ) and HbA1c ( ≥7 % ) failing antihypertensive ( ≥2 medications ) and oral diabetes therapy were enrolled in this three-arm , 12-week , cluster-r and omized study . Participants used DMO ( includes digital medicines , the wearable sensor patch , and the mobile device app ) for 4 or 12 weeks or received usual care based on site r and omization . Providers in the DMO arms could review the DMO data via a Web portal . In all three arms , providers were instructed to make medical decisions ( medication titration , adherence counseling , education , and lifestyle coaching ) on all available clinical information at each visit . Primary outcome was change in SBP at week 4 . Other outcomes included change in SBP and HbA1c at week 12 , and low-density lipoprotein cholesterol ( LDL-C ) and diastolic blood pressure ( DBP ) at weeks 4 and 12 , as well as proportion of patients at BP goal ( < 140/90 mm Hg ) at weeks 4 and 12 , medical decisions , and medication adherence patterns . Results Final analysis included 109 participants ( 12 sites ; age : mean 58.7 , SD years ; female : 49.5 % , 54/109 ; Hispanic : 45.9 % , 50/109 ; income ≤ US $ 20,000 : 56.9 % , 62/109 ; and ≤ high school education : 52.3 % , 57/109 ) . The DMO groups had 80 participants ( 7 sites ) and usual care had 29 participants ( 5 sites ) . At week 4 , DMO result ed in a statistically greater SBP reduction than usual care ( mean –21.8 , SE 1.5 mm Hg vs mean –12.7 , SE 2.8 mmHg ; mean difference –9.1 , 95 % CI –14.0 to –3.3 mm Hg ) and maintained a greater reduction at week 12 . The DMO groups had greater reductions in HbA1c , DBP , and LDL-C , and a greater proportion of participants at BP goal at weeks 4 and 12 compared with usual care . The DMO groups also received more therapeutic interventions than usual care  . Medication adherence was ≥80 % while using the DMO . The most common adverse event was a self-limited rash at the wearable sensor site ( 12 % , 10/82 ) . Conclusions For patients failing hypertension and diabetes oral therapy , this DMO , which provides dose-by-dose feedback on medication ingestion adherence , can help lower BP , HbA1c , and LDL-C , and promote patient engagement and provider decision making . Trial Registration Clinical trials.gov NCT02827630 ; https:// clinical trials.gov/show/NCT02827630 ( Archived by WebCite at http://www.webcitation.org/6rL8dW2VF OBJECTIVES The aim was to determine the impact of a telephone counseling service , provided bi-monthly by pharmacist , on patients ' beliefs about antihypertensive medicines and blood pressure ( BP ) control . METHODS Either hypertensive patients were r and omly assigned to a control group ( CG , usual care ) or an intervention group ( IG ) .  All patients had BP values registered and filled in the Italian version of the Belief Medicine Question naire ( BMQ ) . After 12 months , patients filled in the BMQ again and had their self-reported BP registered . The intervention consisted of an educational/counseling session based on patients ' needs assessment provided bi-monthly by a pharmacist for one year via telephone . RESULTS 80 CG and 84 IG patients were recruited . After 12 months , there were significant differences between IG and CG for both BMQ 's Necessity and Concern score ( p < 0.001 ; p < 0.001 respectively ) and a significant reduction in BP values in IG ( p < 0.001 ) . CONCLUSIONS The intervention improves BP control by modifying patients ' perception about treatments and involving patients as participants in the management of their health . PRACTICE IMPLICATION S This paper could serve as a guideline for other studies to confirm the effectiveness of this intervention in modifying health behavior , and the role of hospital pharmacist Background Hypertension is a major risk factor for cardiovascular disease , and its control rate has remained low worldwide . Studies have found that telemonitoring blood pressure ( BP ) helped control hypertension in r and omized controlled trials . However , little is known about its effect in a structured primary care model in which primary care physicians ( PCPs ) are partnering with cardiology specialists in electronic healthcare data sharing and medical interventions . This study aims to identify the effects of a coordinated PCP-cardiologist model that applies telemedicine tools to facilitate community hypertension control in China . Methods / design Patients with hypertension receiving care at four community healthcare centers that are academically affiliated to Shanghai Chest Hospital , Shanghai JiaoTong University are eligible if they have had uncontrolled BP in the previous 3 months and access to mobile Internet . Study subjects are r and omly assigned to three interventional groups : ( 1 ) usual care ; ( 2 ) home-based BP telemonitor with embedded Global System for Mobile Communications ( GSM ) module and unlimited data plan , an app to access personal healthcare record and receive personalized lifestyle coaching contents , and proficiency training of their use ; or ( 3 ) this plus coordinated PCP-cardiologist care in which PCPs and cardiologists share data via a secure CareLinker website to determine interventional approaches . The primary outcome is mean change in systolic blood pressure over a 12-month period . Secondary outcomes are changes of diastolic blood pressure , HbA1C , blood lipids , and medication adherence measured by the eight-item Morisky Medication Adherence Scale . Discussion This study will determine whether a coordinated PCP-Cardiologist Telemedicine Model that incorporates the latest telemedicine technologies will improve hypertension care . Success of the model would help streamline the present community healthcare processes and impact a greater number of patients with uncontrolled hypertension . Trial registration Clinical Trials.gov , NCT02919033 . Registered on 23 September 2016 Background Only approximately half of patients with hypertension have their blood pressure controlled , due in large part to the tendency of primary care providers ( PCPs ) not to intensify treatment when blood pressure values are elevated . Objective This study tested the effect of an intervention design ed to help patients ask questions at the point of care to encourage PCPs to appropriately intensify blood pressure treatment . Methods PCPs and their patients with hypertension ( N=500 ) were recruited by letter and r and omized into 2 study groups : ( 1 ) intervention condition in which patients used a fully automated website each month to receive tailored messages suggesting questions to ask their PCP to improve blood pressure control  , and ( 2 ) control condition in which a similar tool suggested questions to ask about preventive services ( eg , cancer screening ) . The Web-based tool was design ed to be used during each of the 12 study months and before scheduled visits with PCPs . The primary outcome was the percentage of patients in both conditions with controlled blood pressure . Results Of 500 enrolled patients ( intervention condition : n=282 ; control condition : n=218 ) , 418 ( 83.6 % ) completed the 12-month follow-up visit . At baseline , 289 ( 61.5 % ) of participants had controlled blood pressure . Most ( 411/500 , 82.2 % ) participants used the intervention during at least 6 of 12 months and 222 ( 62.5 % ) reported asking questions directly from the Web-based tool . There were no group differences in asking about medication intensification and there were no differences in blood pressure control after 12 months between the intervention condition ( 201/282 , 71.3 % ) and control condition ( 143/218 , 65.6 % ; P=.27 ) groups . More intervention condition participants discussed having a creatinine test ( 92 , 52.6 % vs 49 , 35.5 % ; P=.02 ) and urine protein test ( 81 , 44.8 % vs 21 , 14.6 % ; P<.001 ) , but no group differences were observed in the rate of testing . The control condition participants reported more frequent discussion s about tetanus and pneumonia vaccines and reported more tetanus ( 30 , 13.8 % vs 15 , 5.3 % ; P=.02 ) and pneumonia ( 25 , 11.5 % vs 16 , 5.7 % ; P=.02 ) vaccinations after 12 months . Conclusions The use of an interactive website design ed to overcome clinical inertia for hypertension care did not lead to improvements in blood pressure control . Participant adherence to the intervention was high . The control intervention led to positive changes in the use of preventive services ( eg , tetanus immunization ) and the intervention condition led to more discussion s of hypertension-relevant tests ( eg , serum creatinine and urine protein ) . By providing patients with individually tailored questions to ask during PCP visits , this study demonstrated that participants were likely to discuss the questions with PCPs . These discussion s did not , however , lead to improvements in blood pressure control . Trial Registration Clinical Trials.gov NCT00377208 ; http:// clinical trials.gov/ct2/show/NCT00377208 ( Archived by WebCite at http://www.webcitation.org/6IqWiPLon ) Context — Very few patient-centered , theory-guided programs for medication adherence and blood pressure control have been conducted in kidney transplant recipients . Objective — To evaluate preliminary indications of sustainability of improved blood pressure in kidney transplant recipients 12 months after completion of a 3-month r and omized controlled trial of a mobile health pilot program to improve blood pressure and medication adherence . Participants and Design — A total of 18 of the 19 trial participants were contacted and all consented to inclusion in the retrospective analysis of their medical records showing their clinic-recorded systolic blood pressures at 3 , 6 , and 12 months following participation in the 3-month trial of a medical regimen self-management intervention . Results — A significant group difference in systolic blood pressure was observed longitudinally , indicating that the intervention group , as compared with the st and ard-care group , exhibited lower clinic-measured systolic blood pressures at the 12-month posttrial follow-up visit ( P = .01 ) . At 12-month follow-up , success in establishing and sustaining control of systolic blood pressure ( < 131 mm Hg ) was greater in the intervention group ( 50 % ) than in the control group ( 11 % ) . Conclusion — Patients in the intervention group continued to exhibit lower systolic blood pressure than did patients in the control group 12 months after the trial ended , suggesting that the intervention may have a durable impact on blood pressure control that most likely reflects sustained medication adherence . These findings will aid in the development of an adequately powered r and omized controlled trial to address the sustainable impact of the intervention program on medication adherence and blood pressure control BACKGROUND Web-based self-management programs offer a novel approach for self-insured employers seeking to improve and maintain employee health . METHODS We conducted a 6-month prospect i ve , cluster-r and omized controlled trial design ed to evaluate whether worksite access to an automated , web-based , self-management program result ed in better blood pressure control . The trial was conducted at 6 EMC Corporation worksites in Massachusetts , each of which had at least 600 employees ; 404 EMC employees with pre-hypertension or hypertension participated . Participants at 3 worksites received a home blood pressure cuff that uploaded readings to a Web site where they could view trends and read automated rules-based messages . Participants at 3 worksites received access to an onsite blood pressure cuff . Primary outcome measure was change in systolic blood pressure . Secondary outcome measures were change in diastolic blood pressure , proportion of participants achieving significant changes in systolic and diastolic blood pressure , and subject satisfaction . RESULTS Although the mean change in systolic blood pressure was not significantly different between intervention and control groups ( -1.69 vs. -0.86 mm HG , respectively , P = .49 ) the change in diastolic blood pressure between groups was significant . ( -1.08 vs. = 1.47 mm HG , respectively , P < .001 ) . Significantly more intervention participants experienced a > 10-mm Hg decrease in systolic blood pressure or > 5-mm Hg decrease in diastolic blood pressure compared to controls ( 22 % vs 17 % , P = .02 and 29 % vs 16 % , P = .03 , respectively ) . Intervention participants were twice as likely to report starting a new medication ( P = .02 ) and more likely to report improved communication with their doctor ( P = .02 ) . CONCLUSIONS Participation in an automated online self-management program result ed in improved blood pressure among employees with prehypertension or hypertension Introduction There is important evidence on the beneficial effects of treatment of cardiovascular risk factors in terms of morbidity and mortality , but important challenges remain in motivating patients to adhere to their treatment regimen . This study aim ed to describe the effectiveness of a quality improvement intervention that included information and regular encouragement by email or letter on cardiovascular risk factors for patients at high risk for cardiovascular disease . Methods This r and omized single-blind study included patients of both sexes aged between 45 and 80 years old who had increased cardiovascular risk . Patients were r and omly allocated to either a usual care group ( UCG ) or advanced care group ( ACG ) . Patients in the UCG received regular care while patients in the ACG received usual care plus regular information and encouragement on cardiovascular risk factors by email or letter . Visits for both groups were planned at 0 , 3 , and 6 months . The outcome measures were blood pressure , weight , body mass index ( BMI ) , waist circumference ( WC ) , and smoking status . Results Out of 178 eligible patients from one single primary care practice , 55 participated in the study , three of whom dropped out . After 6 months , there was a significant decrease in mean systolic and diastolic blood pressure in the UCG and ACG ( P < 0.05 ) . The decreases were already significant after 3 months , except for systolic blood pressure in the UCG . There was also a significant increase in the proportion of patients who met the target values for blood pressure in the UCG and ACG . There was a nonsignificant decrease of the average weight in the ACG , but significantly more patients lost weight in the UCG ( P = 0.02 ) . BMI , WC , and smoking status did not change in either group . Conclusion This study found that there was a significant decrease of systolic and diastolic blood pressure in both study groups . Weight , BMI , WC , and smoking did not improve in either group . Information on cardiovascular risk factors and encouragement by means of letters or email did not provide additional benefits . Thus , effective patient empowerment probably requires more behaviorally sophisticated support to increase self-management , self-efficacy , and self-esteem in patients Introduction Fewer than half of all people at highest risk of a cardiovascular event are receiving and adhering to best practice recommendations to lower their risk . In this project , we examine the role of an e-health-assisted consumer-focused strategy as a means of overcoming these gaps between evidence and practice . Consumer Navigation of Electronic Cardiovascular Tools ( CONNECT ) aims to test whether a consumer-focused e-health strategy provided to Aboriginal and Torres Strait Isl and er and non-indigenous adults , recruited through primary care , at moderate-to-high risk of a cardiovascular disease event will improve risk factor control when compared with usual care . Methods and analysis R and omised controlled trial of 2000 participants with an average of 18 months of follow-up to evaluate the effectiveness of an integrated consumer-directed e-health portal on cardiovascular risk compared with usual care in patients with cardiovascular disease or who are at moderate-to-high cardiovascular disease risk . The trial will be augmented by formal economic and process evaluations to assess acceptability , equity and cost-effectiveness of the intervention . The intervention group will participate in a consumer-directed e-health strategy for cardiovascular risk management . The programme is electronically integrated with the primary care provider 's software and will include interactive smart phone and Internet platforms . The primary outcome is a composite endpoint of the proportion of people meeting the Australian guideline -recommended blood pressure ( BP ) and cholesterol targets . Secondary outcomes include change in mean BP and fasting cholesterol levels , proportion meeting BP and cholesterol targets separately , self-efficacy , health literacy , self-reported point prevalence abstinence in smoking , body mass index and waist circumference , self-reported physical activity and self-reported medication adherence . Ethics and dissemination Primary ethics approval was received from the University of Sydney Human Research Ethics Committee and the Aboriginal Health and Medical Research Council . Results will be disseminated via the usual scientific forums including peer- review ed publications and presentations at international conferences Clinical Trials registration number ACTRN12613000715774 Background Interventions to support people with hypertension in attending clinics and taking their medication have potential to improve outcomes , but delivery on a wide scale and at low cost is challenging . Some trials evaluating clinical interventions using short message service ( SMS ) text-messaging systems have shown important outcomes , although evidence is limited . We have developed a novel SMS system integrated with clinical care for use by people with hypertension in a low-re source setting . We aim to test the efficacy of the system in improving blood pressure control and treatment adherence compared to usual care . Methods / design The SMS Text-message Adherence suppoRt trial ( StAR ) is a pragmatic individually r and omised three-arm parallel group trial in adults treated for hypertension at a single primary care centre in Cape Town , South Africa . The intervention is a structured programme of clinic appointment , medication pick-up reminders , medication adherence support and hypertension-related education delivered remotely using an automated system with either informational or interactive SMS text-messages . Usual care is supplemented by infrequent non-hypertension related SMS text-messages . Participants are 1:1:1 individually r and omised , to usual care or to one of the two active interventions using minimisation to dynamically adjust for gender , age , baseline systolic blood pressure , years with hypertension , and previous clinic attendance . The primary outcome is the change in mean systolic blood pressure at 12-month follow-up from baseline measured with research staff blinded to trial allocation . Secondary outcomes include the proportion of patients with 80 % or more of days medication available , proportion of participants achieving a systolic blood pressure less than 140 mmHg and a diastolic blood pressure less than 90 mmHg , hospital admissions , health status , retention in clinical care , satisfaction with treatment and care , and patient related quality of life . Anonymised demographic data are collected on non- participants . Discussion The StAR trial uses a novel , low cost system based on widely available mobile phone technology to deliver the SMS-based intervention , manage communication with patients , and measure clinical ly relevant outcomes . The results will inform implementation and wider use of mobile phone based interventions for health care delivery in a low-re source setting .Trial registration Background Active engagement in the management of hypertension is important in improving self-management behaviors and clinical outcomes . Mobile phone technology using wireless monitoring tools are now widely available to help individuals monitor their blood pressure , but little is known about the conditions under which such technology can effect positive behavior changes or clinical outcomes . Objective To study the influence of wireless self-monitoring program and patient activation measures on health behaviors , medication adherence , and blood pressure levels as well as control of blood pressure in hypertensive patients . Methods We examined a subset of 95 hypertensive participants from a 6-month r and omized controlled trial design ed to determine the utility of a  wireless self-monitoring program ( n=52 monitoring program , n=43 control ) , which consisted of a blood pressure monitoring device connected with a mobile phone , reminders for self-monitoring , a Web-based disease management program , and a mobile app for monitoring and education , compared with the control group receiving a st and ard disease management program . Study participants provided measures of patient activation , health behaviors including smoking , drinking , and exercise , medication adherence , and blood pressure levels . We assessed the influence of wireless self-monitoring as a moderator of the relationship between patient activation and health behaviors , medication adherence , and control of blood pressure . Results Improvements in patient activation were associated with improvements in cigarette smoking ( beta=−0.46 , P<.001 ) and blood pressure control ( beta=0.04 , P=.02 ) . This relationship was further strengthened in reducing cigarettes ( beta=−0.60 , P<.001 ) , alcohol drinking ( beta=−0.26 , P=.01 ) , and systolic ( beta=−0.27 , P=.02 ) and diastolic blood pressure ( beta=−0.34 , P=.007 ) at 6 months among individuals participating in the wireless self-monitoring program . No differences were observed with respect to medication adherence . Conclusions Participation in a wireless self-monitoring program provides individuals motivated to improve their health management with an added benefit above and beyond that of motivation alone . Hypertensive individuals eager to change health behaviors are excellent c and i date s for mobile health self-monitoring .. Trial Registration Clinical Trials.gov NCT01975428 , https:// clinical trials.gov/ct2/show/NCT01975428 ( Archived by WebCite at http://www.webcitation.org/6iSO5OgOG OBJECTIVE We evaluated the role of home monitoring , communication with pharmacists , medication intensification , medication adherence and lifestyle factors in contributing to the effectiveness of an intervention to improve blood pressure control in patients with uncontrolled essential hypertension . METHODS We performed a mediation analysis of a published r and omized trial based on the Chronic Care Model delivered over a secure patient website from June 2005 to December 2007 . Study arms analyzed included  usual care with a home blood pressure monitor and usual care with home blood pressure monitor and web-based pharmacist care . Mediator measures included secure messaging and telephone encounters ; home blood pressure monitoring ; medications intensification and adherence and lifestyle factors . Overall fidelity to the Chronic Care Model was assessed with the Patient Assessment of Chronic Care ( PACIC ) instrument . The primary outcome was percent of participants with blood pressure ( BP ) < 140/90 mm Hg . RESULTS At 12 months follow-up , patients in the  web-based pharmacist care group were more likely to have BP < 140/90 mm Hg ( 55 % ) compared to patients in the group with home blood pressure monitors only ( 37 % ) ( p = 0.001 ) . Home blood pressure monitoring accounted for 30.3 % of the intervention effect , secure electronic messaging accounted for 96 % , and medication intensification for 29.3 % . Medication adherence and self-report of fruit and vegetable intake and weight change were not different between the two study groups . The PACIC score accounted for 22.0 % of the main intervention effect . CONCLUSIONS The effect of web-based pharmacist care on improved blood pressure control was explained in part through a combination of home blood pressure monitoring , secure messaging , and antihypertensive medication intensification BACKGROUND Prehypertension is considered a precursor of stage 1 hypertension and a predictor of excessive cardiovascular risk . We investigated whether pharmacologic treatment of prehypertension prevents or postpones stage 1 hypertension . METHODS Participants with repeated measurements of systolic pressure of 130 to 139 mm Hg and diastolic pressure of 89 mm Hg or lower , or systolic pressure of 139 mm Hg or lower and diastolic pressure of 85 to 89 mm Hg , were r and omly assigned to receive two years of c and esartan ( Atac and , AstraZeneca ) or placebo , followed by two years of placebo for all . When a participant reached the study end point of stage 1 hypertension , treatment with antihypertensive agents was initiated . Both the c and esartan group and the placebo group were instructed to make changes in lifestyle to reduce blood pressure throughout the trial . RESULTS A total of 409 participants were r and omly assigned to c and esartan , and 400 to placebo . Data on 772 participants ( 391 in the c and esartan group and 381 in the placebo group ; mean age , 48.5 years ; 59.6 percent men ) were available for analysis . During the first two years , hypertension developed in 154 participants in the placebo group and 53 of those in the c and esartan group ( relative risk reduction , 66.3 percent ; P<0.001 ) . After four years , hypertension had developed in 240 participants in the placebo group and 208 of those in the c and esartan group ( relative risk reduction , 15.6 percent ; P<0.007 ) . Serious adverse events occurred in 3.5 percent of the participants assigned to c and esartan and 5.9 percent of those receiving placebo . CONCLUSIONS Over a period of four years , stage 1 hypertension developed in nearly two thirds of patients with untreated prehypertension ( the placebo group ) . Treatment of prehypertension with c and esartan appeared to be well tolerated and reduced the risk of incident hypertension during the study period . Thus , treatment of prehypertension appears to be feasible . ( Clinical Trials.gov number , NCT00227318 . ) BACKGROUND Hypertension is a major contributor to the health and economic burden imposed by stroke , heart disease , and renal insufficiency . Antihypertensives can prevent many of the harmful effects of elevated blood pressure , but medication nonadherence is a known barrier to the effectiveness of these treatments . Smartphone-based applications that remind patients to take their medications , provide education , and allow for social interactions between individuals with similar health concerns have been widely advocated as a strategy to improve adherence but have not been subject to rigorous testing . METHODS / DESIGN The MedISAFE-BP study is a prospect i ve , r and omized control trial design ed to evaluate the impact on blood pressure and medication adherence of an mhealth application ( Medisafe ) .  Four hundred thirteen patients with uncontrolled hypertension have been enrolled and r and omized in a 1:1 fashion to usual care or to the use of the Medisafe mhealth platform  . Patients will be followed up for 12 weeks and the trial 's co- primary outcomes will be change in systolic blood pressure and self-reported medication adherence . DISCUSSION The MedISAFE-BP trial is the first study to rigorously evaluate an mhealth application 's effect on blood pressure and medication adherence . The results will inform the potential effectiveness of this simple system in improving cardiovascular disease risk factors and clinical outcomes Background Despite a variety of efficient and cost-effective antihypertensive medication , hypertension remains a serious health and economic burden . High consumption of cardiovascular drugs in the Slovak Republic does result neither in better hypertension control nor in significant decrease in cardiovascular mortality . At the same time , Slovakia has alarmingly low patients ’ adherence to medication intake . Studies have shown the efficiency of short messaging service ( SMS ) reminders to improve patients ’ adherence and health outcomes at low costs . Since SMS is popular among Slovaks , this approach may be feasible also in Slovakia . The primary objective is to assess if daily SMS reminders of antihypertensive medication intake provided by pharmacists in addition to the st and ard pharmaceutical care increase the proportion of adherent older hypertensive ambulatory patients . Methods The SPPA trial is a pragmatic r and omized parallel group ( 1:1 ) trial in 300 older hypertensive patients carried out in community pharmacies in Slovakia . Trial pharmacies will be selected from all main regions of Slovakia . Trial intervention comprises daily personalized SMS reminders of medication intake embedded into usual pharmaceutical practice . The primary outcome is a combined adherence endpoint consisting of subjective self-reported medication adherence via the eight-item Morisky Medication Adherence Scale ( MMAS-8 ) and objective pill count rate . Secondary outcomes include : change in the MMAS-8 ; comparison of adherence rates using pill count ; change in systolic blood pressure ; and patient satisfaction . Also , direct treatment costs will be evaluated and a cost-effectiveness analysis will be carried out . Discussion The SPPA trial engages community pharmacists and mobile health ( mHealth ) technologies via evidence -based pharmaceutical care to efficiently and cost-effectively addresses current main healthcare challenges : high prevalence of hypertension ; overconsumption of cardiovascular medicines ; low adherence to medication treatment ; and result ing uncontrolled blood pressure . The results may identify new possibilities and capacities in healthcare with low additional costs and high value to patients .Trial registration Clinical Trials.gov , NCT03105687 . Registered on 07 March 2017 Background Patients with chronic conditions often use complex medical regimens . A nurse‐led strategy to support medication therapy management incorporated into primary care teams may lead to improved use of medications for disease control . Electronic health record ( EHR ) tools may offer a lower‐cost , less intensive approach to improving medication management . Methods and Results The Northwestern and Access Community Health Network Medication Education Study is a health center – level cluster‐r and omized trial being conducted within a network of federally qualified community health centers . Health centers have been enrolled in groups of 3 and r and omized to ( 1 ) usual care , ( 2 ) EHR‐based medication management tools alone  , or ( 3 ) EHR tools plus nurse‐led medication therapy management . Patients with uncontrolled hypertension who are prescribed ≥3 medications of any kind are recruited from the centers .  EHR tools include a printed medication list to prompt review at each visit and automated plain‐ language medication information within the after‐visit summary to encourage proper medication use . In the nurse‐led intervention , patients receive one‐on‐one counseling about their medication regimens to clarify medication discrepancies and identify drug‐related concerns , safety issues , and nonadherence . Nurses also provide follow‐up telephone calls following new prescriptions and periodically to perform medication review . The primary study outcome is systolic blood pressure after 1 year . Secondary outcomes include measures of underst and ing of dosing instructions , discrepancies between patient‐reported medications and the medical record , adherence , and intervention costs . Conclusions The Northwestern and Access Community Health Network Medication Education Study will assess the effects of 2 approaches to support outpatient medication management among patients with uncontrolled hypertension in federally qualified health center setting s. Clinical Trial Registration URL : clinical trials.gov . Unique identifier : NCT01578577 Background Hypertension is one of the most important and well-known risk factors for cardiovascular diseases . Unfortunately , in spite of effective treatments , adherence to the regular use of drugs and other nondrug treatments , such as lifestyle improvement , is often poor . This study evaluates the effectiveness of an educational , supportive intervention – in the form of a Blood Pressure Management Application ( BPMAP ) – on self-management in patients with primary hypertension on controlling the determinant factors of hypertension , and on adherence to treatment . Methods / design A two-arm , parallel- design r and omized controlled clinical trial will be conducted on 30 to 60 year-old patients with primary hypertension who are attending the Tehran Heart Center . One hundred and thirty-two ( 132 ) patients will be r and omly assigned to the intervention and control ( usual method ) groups . The most important inclusion criteria are , having primary hypertension and being pharmacologically treated for it , and not having developed the complications of hypertension , such as myocardial infa rct ion , cerebral stroke and cardiac insufficiency . The participants should be able to read Persian and be able to use the application . The most important outcomes of the study include adherence to treatment , weight control , and regular monitoring of blood pressure which are assessed in the primary assessment ( baseline data question naire ) and again at the 8th and 24th weeks . The intervention is a mobile application that has capabilities such as reminders and scientific and supportive information . Discussion This application has been programmed to reduce many of the nonadherence factors of hypertension treatment . Therefore , the findings may contribute to a rise in adherence to treatment . If proven to have an appropriate impact , it may be extended for use in the national hypertension control plan . Trial registration This study was registered in the Iran R and omized Clinical Trial Center under the number I RCT 2015111712211N2 on 1 January 2016 Background : Hypertension frequently accompanies diabetes mellitus , worsening prognosis and complicating medical care for patients . Low medication adherence with multiple medications is a major factor in the inadequate achievement of blood pressure treatment goals . Widespread access to mobile phones offers a new opportunity to communicate with patients and enhance disease self-management . Methods : We recruited 50 high-risk urban patients with hypertension , who are using at least two prescription medications for hypertension , into an open-label trial using medication reminder software on a mobile phone . Medication adherence was assessed by review of pharmacy refill rates before , during , and after availability of the medication reminder software ( pre-activation , activation , and post-activation phase , respectively ) . Results : Forty-eight patients completed the study . All subjects were insured by Medicaid , 96 % were African-American , and the majority had diabetes mellitus . The proportion of days covered for each study phase was as follows : Pre-activation phase = 0.54 , activation phase = 0.58 , and post-activation phase = 0.46 . A significant difference was found between the activation and post-activation phases ( p = .001 ) . The increase in measured adherence between the pre-activation and activation phases approached significance ( p = .057 ) . Forty-six patients completed the pre- and post-Morisky medication adherence survey . The median score rose from 2.0 at baseline to 3.0 at study completion ( p < .001 ) . Average blood pressure and level of control during study period improved significantly after initiation of the study and remained improved from baseline through the course of the study . The 48 subjects who completed the study reported a high level of satisfaction with the medication reminder application at the final study visit . Conclusions : A mobile-phone-based automated medication reminder system shows promise in improving medication adherence and blood pressure in high-cardiovascular-risk individuals Background The majority of North American adult females do not meet current physical activity recommendations ( 150 min of moderate-to-vigorous intensity physical activity ( MVPA ) per week accrued in ≥10 min bouts ) ultimately placing themselves at increased risk of morbidity and mortality . Working-age females face particular challenges in meeting physical activity recommendations as they have multiple dem and s , including occupational , family and social dem and s. To develop effective interventions to increase MVPA among working-age females , it is necessary to identify and underst and the strongest modifiable determinants influencing these behaviours . Therefore , the objective of this systematic review is to examine the available evidence to identify intrapersonal , social and environmental determinants of MVPA among working-age females . Methods / Design Six electronic data bases will be search ed to identify all prospect i ve cohort studies that report on intrapersonal , social and /or environmental determinants of  MVPA  in working-age females . Grey literature sources including theses , published conference abstract s and websites from relevant organizations will also be included . Articles that report on intrapersonal ( e.g. health status , self-efficacy , socio-economic status ( SES ) , stress , depression ) , social environmental ( e.g. crime , safety , area SES , social support , climate and capital , policies ) , and environmental ( e.g. weather , workplace , home , neighbourhood , recreation environment , active transportation ) determinants of MVPA  in a working-age ( mean age 18–65 years ) female population will be included . Risk of bias will be assessed within and across all included studies using the Tool to Assess Risk of Bias in Cohort Studies and the Grade s of Recommendation , Assessment , Development and Evaluation approach . Harvest plots will be used to synthesize results across all determinants , and meta-analyses will be conducted where possible among studies with sufficient homogeneity . Discussion This review will provide a comprehensive examination of evidence in this field and will serve to highlight gaps for future research on the determinants of MVPA in working-age females and ultimately inform intervention design . Systematic review registration PROSPERO : CRD42014009750 OBJECTIVE Hypertension and other noncommunicable diseases represent a growing threat to low/middle-income countries ( LMICs ) . Mobile health technologies may improve noncommunicable disease outcomes , but LMICs lack re sources to provide these services . We evaluated the efficacy of a cloud computing model using automated self-management calls plus home blood pressure ( BP ) monitoring as a strategy for improving systolic BPs ( SBPs ) and other outcomes of hypertensive patients in two LMICs . SUBJECTS AND METHODS This was a r and omized trial with a 6-week follow-up . Participants with high SBPs ( ≥140 mm Hg if nondiabetic and ≥130 mm Hg if diabetic ) were enrolled from clinics in Honduras and Mexico . Intervention patients received weekly automated monitoring and behavior change telephone calls sent from a server in the United States , plus a home BP monitor . At baseline , control patients received BP results , hypertension information , and usual healthcare . The primary outcome , SBP , was examined for all patients in addition to a preplanned subgroup with low literacy or high hypertension information needs . Secondary outcomes included perceived health status and medication-related problems . RESULTS Of the 200 patients recruited , 181 ( 90 % ) completed follow-up , and 117 of 181 had low literacy or high hypertension information needs . The median annual income was $ 2,900 USD , and average educational attainment was 6.5 years . At follow-up intervention patients ' SBPs decreased 4.2 mm Hg relative to controls ( 95 % confidence interval -9.1 , 0.7 ; p=0.09 ) . In the subgroup with high information needs , intervention patients ' average SBPs decreased 8.8 mm Hg ( -14.2 , -3.4 , p=0.002 ) . Compared with controls , intervention patients at follow-up reported fewer depressive symptoms ( p=0.004 ) , fewer medication problems ( p<0.0001 ) , better general health ( p<0.0001 ) , and greater satisfaction with care ( p≤0.004 ) . CONCLUSIONS Automated telephone care management plus home BP monitors can improve outcomes for hypertensive patients in LMICs . A cloud computing model within regional telecommunication centers could make these services available in areas with limited infrastructure for patient-focused informatics support BACKGROUND Approximately half of patients with chronic cardiometabolic conditions are nonadherent with their prescribed medications . Interventions to improve adherence have been only modestly effective because they often address single barriers to adherence , intervene at single points in time , or are imprecisely targeted to patients who may not need adherence assistance . OBJECTIVE To evaluate the effect of a multicomponent , behaviorally tailored pharmacist-based intervention to improve adherence to medications for diabetes , hypertension , and hyperlipidemia . TRIAL DESIGN The STIC2IT trial is a cluster-r and omized pragmatic trial testing the impact of a pharmacist-led multicomponent intervention that uses behavioral interviewing , text messaging , mailed progress reports , and video visits . Targeted patients are those who are nonadherent to glucose-lowering , antihypertensive , or statin medications and who also have evidence of poor disease control . The intervention is tailored to patients ' individual health barriers and their level of health activation . We cluster-r and omized 14 practice sites of a large multispecialty group practice to receive either the pharmacist-based intervention or usual care .  STIC2IT has enrolled 4,076 patients who will be followed up for 12months after r and omization . The trial 's primary outcome is medication adherence , assessed using pharmacy cl aims data . Secondary outcomes are disease control and health care re source utilization . CONCLUSION This trial will determine whether a technologically enabled , behaviorally targeted pharmacist-based intervention results in improved adherence and disease control . If effective , this strategy could be a scalable method of offering tailored adherence support to those with the greatest clinical need Objective The aim of this study was to assess the feasibility and preliminary outcomes of a medication self-management platform for chronically ill patients , Medplan . Methods We performed a 6-month single-arm prospect i ve pre-post intervention study of patients receiving treatment for hypertension and /or dyslipidemia and /or heart failure and /or human immunodeficiency virus infection . During the pre-intervention phase , participants were followed according to their usual care ; during the intervention phase , they used Medplan . We evaluated adherence , health outcomes , healthcare re sources and measured the satisfaction of patients and health care professionals . Results The study population comprised 42 patients . No differences were found in adherence to medication measured by proportion of days covered with medication ( PDC ) . However , when adherence was measured using the SMAQ , the percentage of adherent patients improved during the intervention phase ( p < 0.05 ) , and the number of days with missed doses decreased ( p < 0.05 ) . Adherence measured using the Medplan app showed poor concordance with PDC . No differences were found in health outcomes or in the use of health care re sources during the study period . The mean satisfaction score for Medplan was 7.2 ± 2.7 out of 10 among patients and 7.3 ± 1.7 among health care professionals . In fact , 71.4 % of participants said they would recommend the app to a friend , and 88.1 % wanted to continue using it . Conclusion The Medplan platform proved to be feasible and was well accepted by its users . However , its impact on adherence differed depending on the assessment method . The lack of effect on PDC is mainly because patients were already good adherers at baseline . The study enabled us to vali date the platform in real patients using many different mobile devices and to identify potential barriers to scaling up the platform Background : Comprehensive programs addressing tailored patient self‐management and pharmacotherapy may reduce barriers to cardiovascular disease ( CVD ) risk reduction . Methods : This is a 2‐arm ( clinical pharmacist specialist – delivered , telehealth intervention and education control ) r and omized controlled trial including Veterans with poorly controlled hypertension and /or hypercholesterolemia . Primary outcome was Framingham CVD risk score at 6 and 12 months , with systolic blood pressure ; diastolic blood pressure ; total cholesterol ; low‐density lipoprotein ; high‐density lipoprotein ; body mass index ; and , for those with diabetes , HbA1c as secondary outcomes . Results : Among 428 Veterans , 50 % were African American , 85 % were men , and 33 % had limited health literacy . Relative to the education control group , the clinical pharmacist specialist – delivered intervention did not show a reduction in CVD risk score at 6 months ( −1.8 , 95 % CI −3.9 to 0.3 ; P = .10 ) or 12 months ( −0.3 , 95 % CI −2.4 to 1.7 ; P = .74 ) . No differences were seen in systolic blood pressure , diastolic blood pressure , or low‐density lipoprotein at 6 or 12 months . We did observe a significant decline in total cholesterol at 6 months ( −7.0 , 95 % CI −13.4 to −0.6 ; P = .03 ) in the intervention relative to education control group . Among patients in the intervention group , 34 % received at least 5 of the 12 planned intervention calls and were considered “ compliers . ” A sensitivity analysis of the “ complier average causal effect ” of intervention compared to control showed a mean difference in CVD risk score reduction of 5.7 ( 95 % CI −12.0 to 0.7 ) at 6 months and −1.7 ( 95 % CI −7.6 to 4.8 ) at 12 months . Conclusions : Despite increased access to pharmacist re sources , we did not observe significant improvements in CVD risk for patients r and omized to the intervention compared to education control over 12 months . However , the intervention may have positive impact among those who actively participate , particularly in the short term BACKGROUND R and omized controlled trials have provided unequivocal evidence that treatment of hypertension decreases mortality and major disability from cardiovascular disease ; however , blood pressure remains inadequately treated in most affected individuals . This large gap continues despite the facts that more than 90 % of adults with hypertension have health insurance , and hypertension is the leading cause of visits to the doctor . New approaches are needed to improve hypertension care . OBJECTIVES The Electronic Communications and Home Blood Pressure Monitoring ( e-BP ) study is a three-arm r and omized controlled trial design ed to determine whether care based on the Chronic Care Model and delivered over the Internet improves hypertension care . The primary study outcomes are systolic , diastolic , and blood pressure control ; secondary outcomes are medication adherence , patient self-efficacy , satisfaction and quality of life , and healthcare utilization and costs . METHODS Hypertensive patients receiving care at Group Health medical centers are eligible if they have uncontrolled blood pressure on two screening visits and access to the Web and an e-mail address . Study participants are r and omly assigned to three intervention groups : ( a ) usual care ; ( b ) home blood pressure monitoring receipt and proficiency training on its use and the Group Health secure patient website ( with secure e-mail access to their healthcare provider , access to a shared medical record , prescription refill and other services ) ; or ( c ) this plus pharmacist care management ( collaborative care management between the patient , the pharmacist , and the patient 's physician via a secure patient website and the electronic medical record ) . CONCLUSION We will determine whether a new model of patient-centered care that leverages Web communications , self-monitoring , and collaborative care management improves hypertension control . If this model proves successful and cost-effective , similar interventions could be used to improve the care of large numbers of patients with uncontrolled hypertension BACKGROUND Clinical inertia , provider failure to appropriately intensify treatment , is a major contributor to uncontrolled blood pressure ( BP ) . Some clinical inertia may result from physician uncertainty over the patient ’s usual BP , adherence , or value of continuing efforts to control BP through lifestyle changes . OBJECTIVE To test the hypothesis that providing physicians with uncertainty reduction tools , including 24-h ambulatory BP monitoring , electronic bottle cap monitoring , and lifestyle assessment and counseling , will lead to improved BP control . DESIGN Cluster r and omized trial with five intervention clinics ( IC ) and five usual care clinics ( UCC ) . SETTING Six public and 4 private primary care clinics . PARTICIPANTS A total of 665 patients ( 63 percent African American ) with uncontrolled hypertension ( BP ≥140 mmHg/90 mmHg or ≥130/80 mmHg if diabetic ) . INTERVENTIONS An order form for uncertainty reduction tools was placed in the IC participants ’ charts before each visit and results fed back to the provider . OUTCOME MEASURES Percent with controlled BP at last visit . Secondary outcome was BP changes from baseline . RESULTS Median follow-up time was 24 months . IC physicians intensified treatment in 81 % of IC patients compared to 67 % in UCC ( p < 0.001 ) ; 35.0 % of IC patients and 31.9 % of UCC patients achieved control at the last recorded visit ( p > 0.05 ) . Multi-level mixed effects longitudinal regression modeling of SBP and DBP indicated a significant , non-linear slope difference favoring IC ( p time × group interaction = 0.048 for SBP and p = 0.001 for DBP ) . The model-predicted difference attributable to intervention was −2.8 mmHg for both SBP and DBP by month 24 , and −6.5 mmHg for both SBP and DBP by month 36 . CONCLUSIONS The uncertainty reduction intervention did not achieve the pre-specified dichotomous outcome , but led to lower measured BP in IC patients ABSTRACT BACKGROUND To appropriately manage uncontrolled hypertension , clinicians must decide whether blood pressure ( BP ) is above goal due to a need for additional medication or to medication nonadherence . Yet , clinicians are poor judges of adherence , and uncertainty about adherence may promote inertia with respect to medication modification . OBJECTIVE We aim ed to determine the effect of sharing electronically-measured adherence data with clinicians on the management of uncontrolled hypertension . DESIGN This was a cluster r and omized trial . PARTICIPANTS Twenty-four primary care providers ( 12 intervention , 12 usual care ; cluster units ) and 100 patients with uncontrolled hypertension ( 65 intervention , 35 usual care ) were included in the study . INTERVENTIONS At one visit per patient , clinicians in the intervention group received a report summarizing electronically measured adherence to the BP regimen and recommended clinical actions . Clinicians in the control group did not receive a report . MAIN MEASURES The primary outcome was the proportion of visits with appropriate clinical management ( i.e. , treatment intensification among adherent patients and adherence counseling among nonadherent patients ) . Secondary outcomes included patient-rated quality of care and communication during the visit . KEY RESULTS The proportion of visits with appropriate clinical management was higher in the intervention group than the control group ( 45 out of 65 ; 69 % ) versus ( 12 out of 35 ; 34 % ; p = 0.001 ) . A higher proportion of adherent patients in the intervention group had their regimen intensified ( p = 0.01 ) , and a higher proportion of nonadherent patients in the intervention group received adherence counseling ( p = 0.005 ) . Patients in the intervention group were more likely to give their clinician high ratings on quality of care ( p = 0.05 ) , and on measures of patient-centered ( p = 0.001 ) and collaborative communication ( p = 0.02 ) . CONCLUSIONS Providing clinicians with electronically-measured antihypertensive adherence reports reduces inertia in the management of uncontrolled hypertension . Trial Registration NCT01257347 ; http:// clinical OBJECTIVE To evaluate the feasibility of a web-based coaching programme for vascular risk factor treatment , to describe the patterns of use and to measure changes in risk factors . METHODS Patients with a clinical manifestation of arterial disease and Internet access were asked to participate in the nurse-led Internet-based risk factor management programme . At the first clinic visit , a personalized action plan was made for the treatment of risk factors . Patients were instructed on communication with a specialized nurse through Internet and encouraged to enter self-measured risk factor levels at their personalized website . The nurse practitioner replied on working days and gave feedback , support , and recommendations on lifestyle and medical treatment . After 6 months , risk factors were re-measured . RESULTS Fifty patients participated , 70 % were overweight , 64 % had hypertension , 42 % hyperlipidemia , and 24 % smoked at baseline . During 6 months , the log-in average at the individual website was 35 times per patient ( 1.3 log-ins/week ) ; while the nurse practitioner logged-in at the overall website 23 times/week . The website was hardly used by five patients . Most e-mail messages were sent by patients for hypertension ( 211 times ) and obesity ( 203 times ) , whereas the nurse practitioner sent nearly twice as many e-mail messages for hypertension ( 400 times ) and obesity ( 455 times ) . The level of most risk factors decreased and the fraction of achieved treatment goals increased ( blood pressure from 36 to 58 % , LDL-cholesterol from 58 to 64 % , glucose from 64 to 82 % ) . CONCLUSIONS A web-based vascular risk factor intervention programme is feasible ; it is frequently used by patients and suitable to decrease the level of several risk factors . It has the promise of being an efficacious intervention for risk factor sanitation in patients with symptomatic vascular disease . PRACTICE IMPLICATION S An Internet-based individualised risk management programme could make patients aware of their self-management capability and may contribute to risk factor reduction BACKGROUND Patients ' engagement in mobile health ( m-health ) interventions using interactive voice response ( IVR ) calls is less in low- and middle-income countries ( LMICs ) than in industrialized ones . We conducted a study to determine whether automated telephone feedback to informal caregivers ( " CarePartners " ) increased engagement in m-health support among diabetes and hypertension patients in Bolivia . MATERIAL S AND METHODS Patients with diabetes and /or hypertension were identified through ambulatory clinics affiliated with four hospitals . All patients enrolled with a CarePartner . Patients were r and omized to weekly IVR calls including self-management questions and self-care education either alone ( " st and ard m-health " ) or with automated feedback about health and self-care needs sent to their CarePartner after each IVR call ( " m-health+CP " ) . RESULTS The 72 participants included 39 with diabetes and 53 with hypertension , of whom 19 had ≤6 years of education . After 1,225 patient-weeks of attempted IVR assessment s , the call completion rate was higher among patients r and omized to m-health+CP compared with st and ard m-health ( 62.0 % versus 44.9 % ; p < 0.047 ) . CarePartner feedback more than tripled call completion rates among indigenous patients and patients with low literacy ( p < 0.001 for both ) . M-health+CP patients were more likely to report excellent health via IVR ( adjusted odds ratio [ AOR ] = 2.60 ; 95 % confidence interval [ CI ] , 1.07 , 6.32 ) and less likely to report days in bed due to illness ( AOR = 0.42 ; 95 % CI , 0.19 , 0.91 ) . CONCLUSIONS In this study we found that caregiver feedback increased engagement in m-health and may improve patients ' health status relative to st and ard approaches . M-health+CP represents a scalable strategy for increasing the reach of self-management support in LMICs AIMS The rapidly increasing prevalence of chronic diseases is an important challenge to healthcare systems worldwide . To improve the quality and efficiency of chronic disease care , we investigated the effectiveness and applicability of the Ubiquitous Chronic Disease Care ( UCDC ) system using cellular phones and the internet for overweight patients with both Type 2 diabetes and hypertension . METHODS We conducted a r and omized , controlled clinical trial over 3 months that included 123 patients at a university hospital and a community public health centre . RESULTS After 12 weeks , there were significant improvements in HbA(1c ) in the intervention group ( 7.6 + /- 0.9 % to 7.1 + /- 0.8 % , P < 0.001 ) compared with the control group ( 7.4 + /- 0.9 % to 7.6 + /- 1.0 % , P = 0.03 ) . Furthermore , we observed a significant reduction in systolic and diastolic blood pressure , as well as improvements in total cholesterol , low-density lipoprotein-cholesterol and triglyceride levels in the intervention group . Furthermore , there was a significant increase in adiponectin levels in the intervention group compared with the control group , although high-sensitivity C-reactive protein and interleukin-6 levels did not change in either group . CONCLUSIONS The novel UCDC system presented in this paper improved multiple metabolic parameters simultaneously in overweight patients with both Type 2 diabetes and hypertension BACKGROUND Poor adherence explains poor blood pressure ( BP ) control ; however African Americans suffer worse hypertension-related outcomes . METHODS This r and omized controlled trial evaluated whether a patient education intervention enhanced with positive-affect induction and self-affirmation ( PA ) was more effective than patient education ( PE ) alone in improving medication adherence and BP reduction among 256 hypertensive African Americans followed up in 2 primary care practice s. Patients in both groups received a culturally tailored hypertension self-management workbook , a behavioral contract , and bimonthly telephone calls design ed to help them overcome barriers to medication adherence . Also , patients in the PA group received small gifts and bimonthly telephone calls to help them incorporate positive thoughts into their daily routine and foster self-affirmation . The main outcome measures were medication adherence ( assessed with electronic pill monitors ) and within-patient change in BP from baseline to 12 months . RESULTS The baseline characteristics were similar in both groups : the  mean BP was 137/82 mm Hg ; 36 % of the patients had diabetes ; 11 % had stroke ; and 3 % had chronic kidney disease . Based on the intention-to-treat principle , medication adherence at 12 months was higher in the PA group than in the PE group ( 42 % vs 36 % , respectively ; P = .049 ) . The within-group reduction in systolic BP ( 2.14 mm Hg vs 2.18 mm Hg ; P = .98 ) and diastolic BP ( -1.59 mm Hg vs -0.78 mm Hg ; P = .45 ) for the PA group and PE group , respectively , was not significant . CONCLUSIONS A PE intervention enhanced with PA led to significantly higher medication adherence compared with PE alone in hypertensive African Americans . Future studies should assess the cost-effectiveness of integrating such interventions into primary care . Trial Registration clinical trials.gov Identifier : NCT00227175 OBJECTIVE To design and investigate a pharmacist-run intervention using low health literacy flashcards and a smartphone-activated quick response ( QR ) barcoded educational flashcard video to increase medication adherence and disease state underst and ing . DESIGN Prospect i ve , matched , quasi-experimental design . SETTING County health system in Dallas , Texas . PARTICIPANTS Sixty-eight primary care patients prescribed targeted heart failure , hypertension , and diabetes medications INTERVENTION : Low health literacy medication and disease specific flashcards , which were also available as QR-coded online videos , were design ed for the intervention patients . The following vali date d health literacy tools were conducted : Newest Vital Sign ( NVS ) , Rapid Estimate of Adult Literacy Medicine-Short Form , and Short Assessment of Health Literacy-50 . MAIN OUTCOME MEASURES The primary outcome was the difference in medication adherence at 180 days after pharmacist intervention compared with the control group , who were matched on the basis of comorbid conditions , targeted medications , and medication class . Medication adherence was measured using a modified Pharmacy Quality Alliance proportion of days covered ( PDC ) calculation . Secondary outcomes included 90-day PDC , improvement of greater than 25 % in baseline PDC , and final PDC greater than 80 % . Linear regression was performed to evaluate the effect of potential confounders on the primary outcome . RESULTS Of the 34 patients receiving the intervention , a majority of patients scored a high possibility of limited health literacy on the NVS tool ( 91.2 % ) . The medication with the least adherence at baseline was metformin , followed by angiotensin-converting enzyme inhibitors and beta blockers . At 180 days after intervention , patients in the intervention group had higher PDCs compared with their matched controls ( 71 % vs. 44 % ; P = 0.0069 ) . CONCLUSION The use of flashcards and QR-coded prescription bottles for medication and disease state education is an innovative way of improving adherence to diabetes , hypertension , and heart failure medications in a low-health literacy patient population Introduction Rising burden of cardiovascular disease ( CVD ) and diabetes is a major challenge to the health system in India . Innovative approaches such as mobile phone technology ( mHealth ) for electronic decision support in delivering evidence -based and integrated care for hypertension , diabetes and comorbid depression have potential to transform the primary healthcare system . Methods and analysis mWellcare trial is a multicentre , cluster r and omised controlled trial evaluating the clinical and cost-effectiveness of a mHealth system and nurse managed care for people with hypertension and diabetes in rural India .  mWellcare system is an And roid-based mobile application design ed to generate algorithm-based clinical management prompts for treating hypertension and diabetes and also capable of storing health records , sending alerts and reminders for follow-up and adherence to medication . We recruited a total of 3702 participants from 40 Community Health Centres ( CHCs ) , with ≥90 at each of the CHCs in the intervention and control ( enhanced care ) arms . The primary outcome is the difference in mean change ( from baseline to 1 year ) in systolic blood pressure and glycated haemoglobin ( HbA1c ) between the two treatment arms . The secondary outcomes are difference in mean change from baseline to 1 year in fasting plasma glucose , total cholesterol , predicted 10-year risk of CVD , depression , smoking behaviour , body mass index and alcohol use between the two treatment arms and cost-effectiveness . Ethics and dissemination The study has been approved by the institutional Ethics Committees at Public Health Foundation of India and the London School of Hygiene and Tropical Medicine . Findings will be disseminated widely through peer- review ed publications , conference presentations and other mechanisms . Trial registration mWellcare trial is registered with Clinical trial.gov ( Registration number NCT02480062 ; Pre- results ) and Clinical Trial Registry of India ( Registration number CTRI/2016/02/006641 ) . The current version of the protocol is Version 2 date d 19 October 2015 and the study sponsor is Public Health Foundation of India , Gurgaon , India ( www.phfi.org ) Clinical inertia is a major contributor to poor  blood pressure ( BP ) control . The authors tested the effectiveness of an intervention targeting physician , patient , and office system factors with regard to outcomes of clinical inertia and BP control . A total of 591 adult primary care patients with elevated BP ( mean systolic BP ≥ 140 mm Hg or mean diastolic BP ≥ 90 mm Hg ) were r and omized to intervention or usual care .  An outreach coordinator raised patient and provider awareness of unmet BP goals , arranged BP-focused primary care clinic visits , and furnished providers with treatment decision support . The intervention reduced clinical inertia ( -29 % vs -11 % , P=.001 ) . Nonetheless , change in BP did not differ between intervention and usual care ( -10.1/-4.1 mm Hg vs -9.1/-4.5 mm Hg , P=.50 and 0.71 for systolic and diastolic BP , respectively ) . Future primary care-focused interventions might benefit from the use of specific medication titration protocol s , treatment adherence support , and more sustained patient follow-up visits Antihypertensive drug adherence ( ADA ) is a mainstay in blood pressure control . Education through mobile phone short message system ( SMS ) text messaging could improve ADA . The authors conducted a r and omized study involving 314 patients with hypertension with < 6 months of antihypertensive treatment from the Preventive Health Program of 12 different primary care centers in Santiago , Chile . Patients were r and omly assigned to receive or not receive SMS related to ADA and healthy lifestyle .  Adherence was assessed by the self-reported four-item scale Morisky-Green-Levine question naire at baseline and after 6 months of follow-up , with four of four positive questions classified as good adherence . Group comparison for adherence was performed by means of a logistic regression model , adjusting by baseline adherence , age older than 60 years , and sex . A total of 163 patients were r and omized to receive and 151 to not receive SMS . After 6 months of follow-up , ADA in the non-SMS group decreased from 59.3 % to 51.4 % ( P=.1 ) . By contrast , adherence increased from 49 % to 62.3 % ( P=.01 ) in the SMS group . Text messaging intervention  improved ADA ( risk ratio , 1.3 ; 95 % confidence interval , 1.0 - 1.6 [ P<.05 ] ) . At 6-month follow-up , text messaging result ed in an increase in reporting ADA in this hypertensive Latino population . This approach could become an effective tool to overcome poor medication adherence in the community Background Multiple r and omized controlled trials ( RCTs ) show that behavioral lifestyle interventions are effective in improving diabetes management and that comprehensive risk factor management improves cardiovascular disease ( CVD ) outcomes . The role of technology has been gaining strong support as evidence builds of its potential to improve diabetes management ; however , evaluation of its impact in minority population s is limited . This study intends to provide early evidence of a theory-driven intervention , Tablet-Aided BehavioraL intervention EffecT on Self-management skills ( TABLETS ) , using real-time videoconferencing for education and skills training . We examine the potential for TABLETS to improve health risk behaviors and reduce CVD risk outcomes among a low-income African American ( AA ) population with poorly controlled type 2 diabetes . Methods The study is a two-arm , pilot controlled trial that r and omizes 30 participants to the TABLETS intervention and 30 participants to a usual care group . Blinded outcome assessment s will be completed at baseline , 2.5 months ( immediate post-intervention ) , and 6.5 months ( follow-up ) . The TABLETS intervention consists of culturally tailored telephone-delivered diabetes education and skills training delivered via videoconferencing on tablet devices , with two booster sessions delivered via tablet-based videoconferencing at 3 months and 5 months to stimulate ongoing use of the tablet device with access to intervention material s via videoconferencing slides and a manual of supplementary material s. The primary outcomes are physical activity , diet , medication adherence , and self-monitoring behavior , whereas the secondary outcomes are HbA1c , low-density lipoprotein cholesterol ( LDL-C ) , BP , CVD risk , and quality of life . Discussion This study provides a unique opportunity to assess the feasibility and efficacy of a theory-driven , tablet-aided behavioral intervention that utilizes real-time videoconferencing technology for education and skills training on self-management behaviors and quality of life among a high-risk , low-income AA population with an uncontrolled dyad or triad of CVD risk factors ( diabetes with or without hypertension or hyperlipidemia ) . The intervention leverages the use of novel technology for education and skill-building to foster improved diabetes self-management . The findings of this study will inform the process of disseminating the intervention to a broader and larger sample of people and can potentially be refined to align with clinical workflows that target a sub sample of patients with poor diabetes self-management . Trial registration The trial was registered in April 2014 with the United States National Institutes of Health Clinical Trials Registry ( Clinical Trials.gov identifier NCT02128854 ) , available online at : http:// clinical trials.gov/ct2/show/NCT02128854 M eeting the complex needs of patients with chronic illness or impairment is the single greatest challenge facing organized medical practice . Usual care is not doing the job ; dozens of surveys and audits have revealed that sizable proportions of chronically ill patients are not receiving effective therapy , have poor disease con- trol , and are unhappy with their care ( 1 ) . Results of r and omized trials also show that effective disease management programs can achieve substantially better outcomes than usual care , the control intervention . These trials , along with the ideas and efforts for improvement discussed in this issue , show that we can improve care and outcomes . As the articles suggest , these improvements will not come easily . If we are to improve care for most patients with chronic illness , the evidence strongly suggests that we reshape our ambulatory care systems for this purpose . Pri- mary care practice was largely design ed to provide ready access and care to patients with acute , varied problems , with an emphasis on triage and patient flow ; short appointments ; diagnosis and treatment of symptoms and signs ; reliance on laborato- ry investigations and prescriptions ; brief , didactic patient education ; and patient- initiated follow-up . Patients and families struggling with chronic illness have differ- ent needs , and these needs are unlikely to be met by an acute care organization and culture . They require planned , regular interactions with their caregivers , with a focus on function and prevention of exacerbations and complications . This interac- tion includes systematic assessment s , attention to treatment guidelines , and behav- iorally sophisticated support for the patient 's role as self-manager . These interactions must be linked through time by clinical ly relevant information systems and continu- ing follow-up initiated by the medical practice . Comprehensive System CONTEXT Weight loss , sodium reduction , increased physical activity , and limited alcohol intake are established recommendations that reduce blood pressure ( BP ) . The Dietary Approaches to Stop Hypertension ( DASH ) diet also lowers BP . To date , no trial has evaluated the effects of simultaneously implementing these lifestyle recommendations . OBJECTIVE To determine the effect on BP of 2 multicomponent , behavioral interventions . DESIGN , SETTING , AND PARTICIPANTS R and omized trial with enrollment at 4 clinical centers ( January 2000-June 2001 ) among 810 adults ( mean [ SD ] age , 50 [ 8.9 ] years ; 62 % women ; 34 % African American ) with above-optimal BP , including stage 1 hypertension ( 120 - 159 mm Hg systolic and 80 - 95 mm Hg diastolic ) , and who were not taking antihypertensive medications . INTERVENTION Participants were r and omized to one of 3 intervention groups : ( 1 ) " established , " a behavioral intervention that implemented established recommendations ( n = 268 ) ; ( 2 ) " established plus DASH,"which also implemented the DASH diet ( n = 269 ) ; and ( 3 ) an " advice only " comparison group ( n = 273 ) . MAIN OUTCOME MEASURES Blood pressure measurement and hypertension status at 6 months . RESULTS Both behavioral interventions significantly reduced weight , improved fitness , and lowered sodium intake . The established plus DASH intervention also increased fruit , vegetable , and dairy intake . Across the groups , gradients in BP and hypertensive status were evident . After subtracting change in advice only , the mean net reduction in systolic BP was 3.7 mm Hg ( P<.001 ) in the established group and 4.3 mm Hg ( P<.001 ) in the established plus DASH group ; the systolic BP difference between the established and established plus DASH groups was 0.6 mm Hg ( P = .43 ) . Compared with the baseline hypertension prevalence of 38 % , the prevalence at 6 months was 26 % in the advice only group , 17 % in the established group ( P = .01 compared with the advice only group ) , and 12 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .12 compared with the established group ) . The prevalence of optimal BP ( < 120 mm Hg systolic and < 80 mm Hg diastolic ) was 19 % in the advice only group , 30 % in the established group ( P = .005 compared with the advice only group ) , and 35 % in the established plus DASH group ( P<.001 compared with the advice only group ; P = .24 compared with the established group ) . CONCLUSION Individuals with above-optimal BP , including stage 1 hypertension , can make multiple lifestyle changes that lower BP and reduce their cardiovascular disease risk Objective To assess whether non- clinical staff can effectively manage people at high risk of cardiovascular disease using digital health technologies . Design Pragmatic , multicentre , r and omised controlled trial . Setting 42 general practice s in three areas of Engl and . Participants Between 3 December 2012 and 23 July 2013 we recruited 641 adults aged 40 to 74 years with a 10 year cardiovascular disease risk of 20 % or more , no previous cardiovascular event , at least one modifiable risk factor ( systolic blood pressure ≥140 mm Hg , body mass index ≥30 , current smoker ) , and access to a telephone , the internet , and email . Participants were individually allocated to intervention ( n=325 ) or control ( n=316 ) groups using automated r and omisation stratified by site , minimised by practice and baseline risk score . Interventions Intervention was the Healthlines service ( alongside usual care ) , comprising regular telephone calls from trained lay health advisors following scripts generated by interactive software . Advisors facilitated self management by supporting participants to use online re sources to reduce risk factors , and sought to optimise drug use , improve treatment adherence , and encourage healthier lifestyles . The control group comprised usual care alone . Main outcome measures The primary outcome was the proportion of participants responding to treatment , defined as maintaining or reducing their cardiovascular risk after 12 months . Outcomes were collected six and 12 months after r and omisation and analysed masked . Participants were not masked . Results 50 % ( 148/295 ) of participants in the intervention group responded to treatment compared with 43 % ( 124/291 ) in the control group ( adjusted odds ratio 1.3 , 95 % confidence interval 1.0 to 1.9 ; number needed to treat=13 ) ; a difference possibly due to chance ( P=0.08 ) . The intervention was associated with reductions in blood pressure ( difference in mean systolic −2.7 mm Hg ( 95 % confidence interval −4.7 to −0.6 mm Hg ) , mean diastolic −2.8 ( −4.0 to −1.6 mm Hg ) ; weight −1.0 kg ( −1.8 to −0.3 kg ) , and body mass index −0.4 ( −0.6 to −0.1 ) but not cholesterol −0.1 ( −0.2 to 0.0 ) , smoking status ( adjusted odds ratio 0.4 , 0.2 to 1.0 ) , or overall cardiovascular risk as a continuous measure ( −0.4 , −1.2 to 0.3 ) ) . The intervention was associated with improvements in diet , physical activity , drug adherence , and satisfaction with access to care , treatment received , and care coordination . One serious related adverse event occurred , when a participant was admitted to hospital with low blood pressure . Conclusions This evidence based telehealth approach was associated with small clinical benefits for a minority of people with high cardiovascular risk , and there was no overall improvement in average risk . The Healthlines service was , however , associated with improvements in some risk behaviours , and in perceptions of support and access to care . Trial registration Current Controlled Trials IS RCT N 27508731 This pilot study evaluated a reinforcement intervention to improve adherence to antihypertensive therapy . Twenty-nine participants were r and omized to st and ard care or st and ard care plus financial reinforcement for 12 weeks . Participants in the reinforcement group received a cell phone to self-record videos of adherence  , for which they earned rewards . These participants sent videos demonstrating on-time adherence 97.8 % of the time . Pill count adherence differed significantly between the groups during treatment , with 98.8%±1.5 % of pills taken during treatment in the reinforcement condition vs 92.6%±9.2 % in st and ard care ( P<.002 ) . Benefits persisted throughout a 3-month follow-up , with 93.8%±9.3 % vs 78.0%±18.5 % of pills taken ( P<.001 ) . Pill counts correlated significantly ( P<.001 ) with self-reports of adherence , which also differed between groups over time ( P<.01 ) . Systolic blood pressure decreased modestly over time in participants overall ( P<.01 ) but without significant time-by-group effects . These results suggest that reinforcing medication adherence via cellular phone technology and financial reinforcement holds potential to improve adherence AIMS The aim of this study was to test the feasibility and impact of an intervention consisting of self-monitored blood pressure , medicine review , a Digital Versatile Disc , and motivational interviewing telephone calls to help people with diabetes and kidney disease improve their blood pressure control and adherence to prescribed medications . BACKGROUND People with co-existing diabetes , kidney disease and hypertension require multiple medications to manage their health . About 50 % of people are non-adherent to their prescribed medications with non-adherence increasing in the presence of chronic conditions . DESIGN R and omized controlled trial . METHODS Patients aged ≥18 years with diabetes , chronic kidney disease and systolic hypertension were recruited from nephrology and diabetes out patients ' clinics of an Australian metropolitan hospital between 2008 - 2009 . Participants were r and omly allocated on a 1:1 basis to one of two groups in a r and omized controlled trial : the intervention delivered over 3 months ( n = 39 ) and usual care ( n = 41 ) , with follow-up at 3 , 6 and 9 months postintervention . People collecting data and assessing outcomes were blinded to group assignment . RESULTS Seventy-five participants completed the study . The intervention was acceptable and feasible for this cohort . There were no statistically significant differences between groups , although the mean systolic blood pressure reduction in the intervention group ( n = 36 ) was -6·9 mmHg 95 % CI ( -13·8 , -0·02 ) at 9 months postintervention . CONCLUSION The study was feasible and statistically significant differences may be determinable in a larger sample to overcome the variability between groups , paying attention to recommendations for further research . TRIAL REGISTRATION The trial was prospect ively registered with the Australian and New Zeal and Clinical Trials Register ( ACTRN12607000044426 ) ABSTRACT Background : Cardiovascular diseases and diabetes are among the leading causes of premature adult deaths in India . Innovative approaches such as clinical decision support ( CDS ) software could play a major role in improving the quality of hypertension/diabetes care in primary care setting s. Objective : To describe the steps and processes in the development of mWellcare , a complex intervention based on mobile health ( mHealth ) technology . Methods : The Medical Research Council framework was used to develop mWellcare in four steps : ( 1 ) identify gaps in usual care through literature review and health facility assessment s ; ( 2 ) identify the components of the intervention through discussion s and consultations with experts ; ( 3 ) develop intervention ( clinical algorithms and mHealth system ) ; and ( 4 ) evaluate acceptability and feasibility through pilot testing in five community health centers . Results : Lack of evidence -based , integrated , and systematic management of chronic conditions were major gaps identified . Experts in information technology , clinical fields , and public health professionals identified intervention components to address these gaps . Thereafter , clinical algorithm context ualized to primary care setting s were prepared and the mWellcare intervention was developed . During the 2-month pilot , 631 patients diagnosed with hypertension and /or diabetes were registered , with a follow-up rate of 36.2 % . The major barrier was resistance to follow mWellcare recommended patient workflow , and to overcome it , we emphasized onsite training and orientation program to cover all health care team member in each CHC . Conclusion : A pilot-tested mWellcare intervention is an mHealth system with important components , i.e. integrated management of chronic conditions , evidence -based CDS , longitudinal health data and automated short-messaging service to reinforce compliance to drug intake and follow-up visit , which will be used by nurses at primary health care setting s in India . The effectiveness and cost-effectiveness of the intervention will be tested through a cluster r and omized trial ( trial registration number NCT02480062 ) BACKGROUND The Take Control of Your Blood Pressure trial evaluated the effect of a multicomponent telephonic behavioral lifestyle intervention , patient self-monitoring , and both interventions combined compared with usual care on reducing systolic blood pressure during 24 months . The combined intervention led to a significant reduction in systolic blood pressure compared with usual care alone . We examined direct and patient time costs associated with each intervention . METHODS We conducted a prospect i ve economic evaluation alongside a r and omized controlled trial of 636 patients with hypertension participating in the study interventions .  Medical costs were estimated using electronic data representing medical services delivered within the health system . Intervention-related costs were derived using information collected during the trial , administrative records , and published unit costs . RESULTS During 24 months , patients incurred a mean of $ 6,965 ( s.d . , $ 22,054 ) in inpatient costs and $ 8,676 ( s.d . , $ 9,368 ) in outpatient costs , with no significant differences among the intervention groups . With base-case assumptions , intervention costs were estimated at $ 90 ( s.d . , $ 2 ) for home blood pressure monitoring , $ 345 ( s.d . , $ 64 ) for the behavioral intervention ( $ 31 per telephone encounter ) , and $ 416 ( s.d . , $ 93 ) for the combined intervention . Patient time costs were estimated at $ 585 ( s.d . , $ 487 ) for home monitoring , $ 55 ( s.d . , $ 16 ) for the behavioral intervention , and $ 741 ( s.d . , $ 529 ) for the combined intervention . CONCLUSIONS Our analysis demonstrated that the interventions are cost-additive to the health-care system in the short term and that patients ' time costs are nontrivial BACKGROUND Many strategies have been evaluated to improve the prevention and control of cardiovascular ( CVD ) risk factors . Nursing telephonic and tele-counseling individualized lifestyle educational programs have been found to improve blood pressure control and adherence to lifestyle recommendation . This study tested the efficacy of a nurse-led reminder program through email ( NRP-e ) to improve CVD risk factors among hypertensive adults . METHODS All participants received usual CVD prevention and a guideline -based educational program . Subjects in the NRP-e group also received weekly email alerts and phone calls from a nurse care manager for 6 months . Emails contained a reminder program on the need for adherence with a healthy lifestyle based upon current guidelines . Follow-up visits were scheduled at 1 , 3 and 6 months after enrollment ; r and omization was made central ly and blood sample s were evaluated into a single laboratory . RESULTS The final sample consisted of 98 ( control ) and 100 ( NRP-e ) subjects ( mean age 59.0 ± 14.5 years ; 51.0 % males ) . After 6 months , the following CVD risk factors significantly improved in both groups : body mass index , alcohol and fruit consumption , cigarette smoking , adherence to therapy hours , systolic and diastolic blood pressure , fasting blood glucose , low-density lipoproteins ( LDL ) and total cholesterol , triglycerides , and physical activity . In the NRP-e group , however , the prevalence of several behaviors or conditions at risk decreased significantly more than in the control group : obesity ( -16 % ) , low fruit consumption ( -24 % ) , uncontrolled hypertension ( -61 % ) , LDL ( -56 % ) , and total cholesterol ( -40 % ) . CONCLUSIONS The NRP-e improved a range of CVD risk factors . The program had low costs , required only an average of < 20 min per day in addition to normal practice , and may deserve further evaluation for the inclusion among existing care management approaches Self-monitoring of blood glucose is an integral part of diabetes care which may be extended to other biometrics . Cellular and short range communication technologies will be important for the routine usage of these systems . However , the issues of follow-up and patient compliance with these emerging systems have not been yet studied evaluated but could be critical to the adoption of these technologies . We evaluated the impact of mobile telemonitoring on the intensification of care on blood pressure control and exposure to hyperglycaemia in patients with diabetes . We r and omised 137 patients with diabetes to either mobile telemonitoring  ( n = 3D72 ) or usual care patients ( n = 3D65 ) for 9 months . In this paper we present some of the clinical results with focus on blood pressure control hypertension and highlight some of the technical and compliance issues that were encountered OBJECTIVE Examine the impact of a PACE ( Prepare , Ask , Check , Express ) inspired web-based communication intervention alone or combined with a workshop on reaching treatment goals  for patients suffering from chronic diseases ( CDs ) , compared to usual care . METHODS Three arm single-blind RCT in community primary care ( PC ) practice s. PC practitioners ( n=18 ) had a CD patient caseload , and practicing > 5 years . Patients > 40 years old , English speaking , computer literate , not reaching treatment goals for hypertension , type II diabetes , and /or dyslipidemia . INTERVENTIONS ( 1 ) web-intervention and ( 2 ) web intervention and nurse facilitated workshop and ( 3 ) usual care . OUTCOME Proportion of patients meeting all treatment suggested guidelines for the diagnoses they were enrolled for . RESULTS Patients ( n=322 ) were r and omized , and of these 221 returned for follow up . Patients in the web group were 1.42 times more likely to meet targets compared to usual care [ 95 % CI : 1.00 - 2.00 ] , a statistical difference not seen in the combined group . Sensitivity analyses were performed to mitigate bias due to loss to follow up . CONCLUSIONS Training patients in communication skills using a website positively affects reaching treatment goals for hypertensive , diabetic and dyslipidemic patients . PRACTICE IMPLICATION S Web communication interventions are an effective tool that can be used in primary care
target: The most commonly described determinants at the patient level were lack of education , lack of self-awareness , lack of self-efficacy , and forgetfulness .
  Clinical inertia and an inadequate health workforce were the most commonly targeted determinants at the health care team and system level .
  Taking medication , interactive patient-provider communication , self-measurement , and lifestyle management were the most cited patient behaviors at both levels .
  Most of the DIs did not include support from peers or family members , despite its reported effectiveness and the rate of social media penetration .
background: Background Information on how behavior change strategies have been used to design digital interventions ( DIs ) to improve blood pressure ( BP ) control or medication adherence ( MA ) for patients with hypertension is currently limited .
  Objective Hypertension is a major modifiable risk factor for cardiovascular diseases and can be controlled with appropriate medication .
  Many interventions that target MA to improve BP are increasingly using modern digital technologies .
  This systematic review was conducted to discover how DIs have been design ed to improve MA and BP control among patients with hypertension in the recent 10 years .