Pharmacy-based hypertension care employing mHealth in Lagos, Nigeria – a mixed methods feasibility study

Autor: Tochi J. Okwor, René Gerrets, Anne Lia Cremers, Constance Schultsz, Frank van Leth, Heleen E. Nelissen, Lizzy M. Brewster, Olalekan Makinde, Marleen E. Hendriks, Sam Kool, Akin Osibogun, Anja H. van’t Hoog
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
Blood Pressure
Pilot Projects
030204 cardiovascular system & hematology
Pharmacists
Health informatics
Health administration
0302 clinical medicine
Medicine
Prospective Studies
030212 general & internal medicine
mHealth
Sub-Saharan Africa
Health Policy
Nursing research
lcsh:Public aspects of medicine
Health services research
Decentralization
Feasibility
Focus Groups
Middle Aged
Mobile Applications
Task-shifting
Telemedicine
Patient Satisfaction
Pharmacy care
Hypertension
Female
Medical emergency
Private sector
Research Article
Attitude of Health Personnel
Health Personnel
Nigeria
Pharmacy
03 medical and health sciences
Physicians
Humans
Pharmacies
business.industry
Quality of care
Blood Pressure Determination
lcsh:RA1-1270
medicine.disease
Focus group
Blood pressure
Pharmaceutical Services
Feasibility Studies
Self Report
Health Expenditures
business
Facilities and Services Utilization
Zdroj: BMC Health Services Research, Vol 18, Iss 1, Pp 1-14 (2018)
BMC Health Services Research
ISSN: 1472-6963
DOI: 10.1186/s12913-018-3740-3
Popis: Background Access to quality hypertension care is often poor in sub-Saharan Africa. Some community pharmacies offer hypertension monitoring services, with and without involvement of medical doctors. To directly connect pharmacy staff and cardiologists a care model including a mobile application (mHealth) for remote patient monitoring was implemented and pilot tested in Lagos, Nigeria. Pharmacists provided blood pressure measurements and counselling. Cardiologists enrolled patients in the pilot program and remotely monitored them, for which patients paid a monthly fee. We evaluated the feasibility of this care model at five private community pharmacies. Outcome measures were retention in care, blood pressure change, quality of care, and patients’ and healthcare providers’ satisfaction with the care model. Methods Patients participated in the care model’s pilot at one of the five pharmacies for approximately 6–8 months from February 2016. We conducted structured patient interviews and blood pressure measurements at pilot entry and exit, and used exports of the mHealth-application, in-depth interviews and focus group discussions with patients, pharmacists and cardiologists. Results Of 336 enrolled patients, 236 (72%) were interviewed at pilot entry and exit. According to the mHealth data 71% returned to the pharmacy after enrollment, with 3.3 months (IQR: 2.2–5.4) median duration of activity in the mHealth-application. Patients self-reported more visits than recorded in the mHealth data. Pharmacists mentioned use of paper records, understaffing, the application not being user-friendly, and patients’ unwillingness to pay as reasons for underreporting. Mean systolic blood pressure decreased 9.9 mmHg (SD: 18). Blood pressure on target increased from 24 to 56% and an additional 10% had an improved blood pressure at endline, however this was not associated with duration of mHealth activity. Patients were satisfied because of accessibility, attention, adherence and information provision. Conclusion Patients, pharmacists and cardiologists adopted the care model, albeit with gaps in mHealth data. Most patients were satisfied, and their mean blood pressure significantly reduced. Usage of the mHealth application, pharmacy incentives, and a modified financing model are opportunities for improvement. In addition, costs of implementation and availability of involved healthcare providers need to be investigated before such a care model can be further implemented. Electronic supplementary material The online version of this article (10.1186/s12913-018-3740-3) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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