Evidence synthesis paper

Does implementation of mobile web app for medication reminder and health education increases treatment adherence among African American Males?
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Table of Contents
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1.0 Introduction  PAGEREF _Toc368583077 \h
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1.1Background literature and theory related to the problem and discussion of its relevance to the local clinical setting.  PAGEREF _Toc368583078 \h
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1.2 Theoretical Perspective  PAGEREF _Toc368583079 \h
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2.0 Literature Review  PAGEREF _Toc368583080 \h
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2.1 Potential benefits and challenges of addressing the clinical question in the local setting  PAGEREF _Toc368583081 \h
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2.2 Larger contextual impact to this problem  PAGEREF _Toc368583082 \h
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3.0 Critical Appraisal  PAGEREF _Toc368583083 \h
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References  PAGEREF _Toc368583085 \h
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1.0 Introduction
Adherence is important for improved quality of life among hypertensive patients. Non-adherent hypertensive patients have been reported to be at more risk of suffering from and dying from stroke. Studies indicate that patients that fail to take their medication on time have a more than two times risk of dying after few years of taking the prescribed medicine to control hypertension (Christensen, et al., 2009). A Mobile web app designed to alert patients to take their medication improves African American males’ self- management for medication adherence. It aids in chronic disease management by improving patients confidence in adhering to prescribed medication to control blood pressure. I selected the topic from the school suggestions of topics for clinical Scholarly Projects driven by personal passion for increased quality of life among hypertensive African Americans.
Non-adherence to hypertension medication is prevalent among African American men (Lewis, Schoenthhaler, & Ogedegbe, 2012).The rate of non-adherence is unacceptably high in black men even when they have similar access to care and income as compared with their white counterparts. Pharmacy refill studies that measure adherence also confirm that they have considerably low adherence compared to whites. This occurs despite African American males having a good understanding of the potential benefits of adherence and the risks that emanate from non-adherence (Lewis, Schoenthhaler, & Ogedegbe, 2012).
1.1Background literature and theory related to the problem and discussion of its relevance to the local clinical setting.
1.2 Theoretical Perspective
It is important for patients to remember taking prescribed treatments at all times. Research has shown that in most cases, patients do not stick to their medication programs. In fact, a recent survey conducted by the National Association of Community Pharmacist, indicated that more than half of patients failed to take a full description of their medication because they could not remember. The same study also revealed that many patients took a lesser dosage than the recommended. It is against this context that health practitioners are expected to offer services and programs that enhance medical adherence among patients through their mobile phones, smartphones, Ipads, landline or PC. As Dayer, et al (2013) notes, simple systems of medical reminder are significant for patients who require assistance concerning their schedule. Application of mobile webs for this service also befits this criterion.
Application of the mobile Webb in medication reminders for patients is deemed successful since it is apparent that mobile technology is constantly increasing and popular. Majority of people today own either mobile phones, tablets or iPads. Mobile technology is neither alien in medical care. Majority of health practitioners can be found using mobile phones, smart phones, iPads and other communication devices for medical operations and guiding their patients on medications.
2.0 Literature Review
A certain study indicates that between 1999 and 2004, 56 percent of African American men were accessing treatment for hypertension as compared to 60 percent of white men. It also indicates that out of these, only 30 percent of the black men had their blood pressure under control as compared to 39 percent of the white men. In the same period, there were more deaths resulting from hypertension among African American men compared to deaths among African American women and white men. The death rate was at over 30 African American men’s deaths, less than 30 African American women’s deaths and less than 15 white men’s deaths per every 100,000 deaths respectively (Centers for Disease Control and Prevention, 2010).
Owing to high rates of non-adherence to hypertension medication among African American males, incidents of death from heart disease and stroke is higher compared to incidents in white men. The CDC report indicates over four African American men’s deaths and less than two white men’s deaths in every 100000 heart disease related deaths between 1999 and 2004 (Centers for Disease Control and Prevention, 2010).
There are several factors that determine adherence behavior among African American men. One of the main reasons is depression which strongly determines adherence among African American men (Lewis, Schoenthhaler, & Ogedegbe, 2012). African American male patients with chronic illnesses are at risk of suffering from depression and registering low adherence to medication as a result. Age also contributes to non-adherence behavior among African American men and younger men are reported to be more non-adherent compared to the older men (Lewis, Schoenthhaler, & Ogedegbe, 2012).
There is also evidence that indicates that empathetic and cooperative communication with the provider plays a significant role in ensuring adherence in the male African Americans (Lewis, Schoenthhaler, & Ogedegbe, 2012). Mobile web applications can improve African American’s communication with their providers allowing the patients to adhere more to prescriptions. This is because studies have shown that hypertensive African Americans are at a disadvantaged position of accessing quality care compared to whites. Whites are at a more advantaged position to access care from a consistent provider. This is has been directly linked to their success in blood pressure control (Centers for Disease Control and Prevention, 2010).
African American patients have indicated that existence of a trusting and genuine relationship with a provider allows them to adhere to medication and manage their treatment better. In developing good communication, patient centeredness and racially accommodative care approaches are important in offering quality care for African American males (Centers for Disease Control and Prevention, 2010).
Self-efficacy is also another important factor in determining adherence. It is a measure of individual patients’ confidence in remaining adherent to prescribed medication (Lewis, Schoenthhaler, & Ogedegbe, 2012). It is reported that African American men that display low confidence in the ability to remain adherent have a difficulty in medication adherence. It is necessary to implement measures that increase their confidence in taking medication in compliance with their prescription.
Using a mobile web app for reminders and health education improves patient’s self-management in adhering to medication. This way, they are able to develop an adherence routine and deeper understanding of how to achieve better health through implementing health education information. Self-management involves strategies that assist patients to solve problems related to their hypertensive condition. These strategies take cognizance of the fact that patients have a primary role in managing the condition through better health behaviors such as adherence.
Mobile web applications are the new ways of engaging and managing patients in Medicaid programs particularly those with hypertension. Mobile technology is perceived to be widespread, cost effective and efficient in disseminating health information. It is also notable that health information positively impacts adherence, assists in mitigating medical mistakes and improves general health outcomes (Oscar, 2012).
Using the mobile web applications patients receive guidance on how to monitor their adherence habits and prevent risks that result from non-adherence such as stroke. They also receive information on benefits of adherence to medication as well as recommendations on dietary changes that assist them to better manage their dietary intake. It also helps African American males to get rid of misconceptions that hypertension may be treated with home-made regimens. It is an effective strategy that offers information about etiology of hypertension to the African American males and gives them a responsibility of personally managing their condition from a position of knowledge (Hekler, Lambert, Leventhal, Leventhal, Jahn, & Contrada, 2008).
It is estimated that downloads of health related information in the US may reach 142 million by 2016 as the use of smartphones to access health information increases. For instance, in 2011 almost seventeen million people retrieved such information on through different forms of mobile technologies such as smart phones and cell phones. This was a 125 percent increase when compared to 2010 (Oscar, 2012). The health care system uses mobile technology apps to disseminate health plans and reminders at any time and from any location and recipients receive it immediately. It is an effective way of making health information more accessible in a convenient way (Oscar, 2012). This is particularly important in the era of growing Medicaid population.
Poor adherence to prescribed drugs is one of the greatest causes of hospitalization for hypertensive African American male patients. Such patients present with worsening heart disease resulting in subsequent death from coronary heart disease, myocardial infarction and stroke (Pimenta, 2010). Adherent patients tend to register lower blood pressure levels compare to non-adherent patients. Controlling blood pressure is laborious and a combination of factors such as lifestyle change, adherence and patient education play a significant role in its control (Pimenta, 2010). Mobile app technologies are increasingly important in providing education to alter lifestyle tendencies that aggravate hypertension and in increasing compliance with the prescribed medical regimens. Many hypertensive patients accept the use of reminder mobile devices and this indicates a positive trend in management of hypertension (Christensen, et al., 2009).
2.1 Potential benefits and challenges of addressing the clinical question in the local setting
Proliferation of mobile health among African American male patients is promising. This is backed by research done by Pew Internet and American Life Project that indicates that ownership of handsets in the US is higher among African Americans and Hispanics as compared to whites (Atienza & Patrick, 2011). It has also been reported that patients that are subscribed to text message reminder programs present more adherence to oral medication and that it assists them to sustain high adherence behavior over a prolonged period of time (Foreman, et al., 2012). This implies that hypertensive African American males enrolled in such programs shall register better adherence rates to medication and prevent escalation of the disease to more complicated situations such as strokes
Poor adherence to prescribed medication may be as a result of different causes. The most effective way to curb the problems that emanate from non-adherence is in identifying the patients at risk for non-adherence. Mobile web applications assist the health care systems to implement stringent interventions on patients that are likely to follow the treatment regimens provided before the occurrence of the problem (Bosl et al 2013). The apps also enable physicians to identify African American male patients that are at risk for non-adherence. For instance, the MPR monitor app measures a thirty-day gap in a particular patient’s medication record and an alert is sent to the clinician in case a patient has a gap that is greater than thirty days (Bosl, Mandel, Jonikas, Ramoni, Kohane, & Mandl, 2013).
Implementation of the mobile web app among the African American male population may also save the United States an estimated $100 billion per year. The app presents authorized medical practitioners with information that is easy to review and make decisions on required action. This is particularly helpful after early detection of non-adherent patients (Bosl, Mandel, Jonikas, Ramoni, Kohane, & Mandl, 2013). Implementation of the application also faces various challenges.
One of the challenges is that despite the decreasing digital divide between the different ethnic and racial groups in the US, there is a burgeoning digital divide between the young and the old patients. This is linked to differences in generational uptake of technology services that varies between the two generations (Atienza & Patrick, 2011). The generational divide in adoption of technology poses a challenge to implementation of the mobile web application among the older African American male patients especially because hypertension is more prevalent among the older generation than among the younger generation.
Subsequently, it is necessary to merge science and technology to narrow the divide and capitalize on the benefits that mobile health presents (Atienza & Patrick, 2011). It may include having automated phone calls instead of emails or text messages to the elderly to remind them to take their prescription drugs which subsequently reduces human error and saves the country billions that result from resulting negative health complications or outcomes (West, 2012).
Another challenge of using mobile web applications is that there is general fear about potential breach of privacy in case of loss of the mobile devices. African American male patients have a general concern that confidentiality of their health information may be compromised as a result of increased dependence on the devices. This is particularly worrisome when such information is accessed by employers and other private people that may abuse such information (Atienza & Patrick, 2011).
Another challenge is in reimbursement of medical practitioners using the new form of providing medical care. This is because many of the reimbursement policies are drafted in favor of one-on-one consultations and treatment as opposed to mobile web app types of treatment and medical services. This poses a challenge on effecting changes on the reimbursement policies to encourage physicians to make extensive use of the innovations in health service delivery (West, 2012).
2.2 Larger contextual impact to this problem
A mobile web app affects better health outcomes because it allows physicians to get data on their patients’ prognosis without having to conduct routine checks. This allows them to have adequate time to concentrate on more serious hypertension cases requiring more intensive care. It also saves acute hypertensive patients unnecessary trips to the physician’s office as well as save physicians from making unproductive trips to see their patients. Mobile technology also impacts growth for small businesses involved in information communication services as more people access health information. For instance, it is reported that the medical sector contributed to the communication industry productivity by 11.2 billion US dollars in 2011 (West, 2012).
Mobile web app interventions shall also be tailored to address the ethnic and race based issues. It shall address issues such as distrust of care providers, normative beliefs, religious beliefs and general misconceptions through health education and unbiased technology supported instant communication with providers. This is in appreciation of the fact that understanding African American perceptions of adherence to antihypertensive medicines has a large bearing on development of appropriate interventions (Lewis, Askie, Randleman, & Shelton-Dunston, 2010).
Overall, mobile web applications provide a significant way of monitoring hypertensive patients’ adherence and their receipt of health education information. The technology allows patients to also get reminders of appointments from their medical practitioners, to schedule appointments, receive test results through email, access to electronic medical records and use monitoring devices to monitor blood pressure levels and share that information with their doctors. This allows a beneficial communication atmosphere to thrive between doctors and patients and increases positive health outcomes. It also reduces readmission to hospitals or nursing home and increases chances of positive health outcomes.
Christensen, et al, (2009) performed a study to ascertain the effectinveness of a compliance reminder in the medication of hypertension. The authors opted to undetake this assessment after realizing serious issues associated to non compliance of treatment regimes. In particular, the study was purposed to evaluate the acceptance of physicians and patients concerning the effectivess and role of the reminder device. Participants in this study included medical practitioners and pa...