Text Message Communication with Patients

In a single-blind randomized, patients with hypertension in South Africa were divided into three different groups of care. The first group continued the usual way with routine doctor’s appointments. The second group was involved in an information only daily text messaging system and finally, the last group was involved in an interactive text messaging system. The goal of the study was to see how increased interaction with the patient could impact systolic blood pressure over the span of twelve months. The hopes of increased interaction through the text messaging system were that they would increase the adherence and that cognitive thought about their disease state daily would ensure better decision making in their lifestyle choices. The study concluded that there was a greater decrease in the systolic blood pressure of those individuals whom received daily text messages and then only a slight decrease in the individuals with the interactive text messaging.

In the medical world today, it is crucial to be able to keep up with the technology when interacting with patients. Being able to reach patients efficiently, as according to the study, is necessary in maintaining patient adherence. Additionally, being able to be readily available to patients will enable the patient to get questions easily answered and clear up any confusion with medications or therapy regiments. Keeping up with the technology and creating new ways to reach patients is important to maintain the contact with patients throughout the term of a year in between doctor’s visits.

Bobrow, K, Farmer, AJ, et al. Mobile Phone Text Messages to Support Treatment Adherence in Adults with High Blood Pressure (StAR): A Single-Blind Randomized Trial. Circulation Journal. (published 14 January 2016)

CirculationAHA.115.017530

Borrow, K, Farmer, AJ, et al. Mobile Phone Text Messaging to Support Treatment Adherence in Adults with High Blood Pressure. Circulation AHA. Published online January 14, 2016.

Pharmacist-led screening program for an inner-city pediatric population

This study was conducted to see how inner city children are affected by asthma, hypertension, obesity, and environmental tobacco smoke (ETS) exposure. This study took place in lower socioeconomic communities throughout Pittsburgh and pharmacists and student pharmacists ran 12 health screenings on 144 children over the course of 2 years.

The study found that 16% of the children were already diagnosed with asthma before the screenings, and 18% had potential asthma. More than half of the children were not at a healthy weight (0.7% were underweight and the remaining were either overweight or obese), and 24% had abnormal blood pressure. 26% of the children had exposure to ETS comparable to that of smokers.

Over the course of this study, nearly 200 referrals were made by the pharmacists. This study is important because it shows how at risk the children in our own community are for conditions that could greatly affect their health outcomes. It also shows how critical of a role pharmacists could play in screening and preventing diseases among children who face numerous health disparities. Screening programs such as this can be implemented by pharmacists in other communities, especially those of even lower socioeconomic status than the one studied, to help lower health disparities among inner city populations of children.

Elliott JP, Harrison C, Konopka C, et al. Pharmacist-led screening program for an inner-city pediatric population. J Am Pharm Assoc. 2003;55:413-8.

Testing Intensive Hypertension Treatment and Its Positive Effects on Cardiovascular Outcomes

The SPRINT research group conducted a study to determine the beneficial effects of intensive treatment options for hypertension as compared to the standard methods and goals of high blood pressure medication therapy.  In the study, researchers tracked the treatment outcomes of 9,361 patients over the age of 50, systolic blood pressure from 130-180 mm Hg, and increased risk of cardiovascular disease.  They were separated into two groups, one intensive care group (blood pressure goal of <120/80), and a standard care group (blood pressure goal of <140/90), and treated accordingly to lower blood pressure to respective goals.  The two groups were then monitored over the course of five years to measure adverse cardiovascular outcomes including myocardial infarction, stroke, coronary artery disease, heart failure, or death from cardiovascular complications.

The study found that those treated for hypertension with intensive therapeutic goals were less likely to experience adverse cardiovascular outcomes or death associated with cardiovascular complications as compared to the study group that was treated with the current standard goals of blood pressure therapy.  Intensive treatment showed protective effects on primary adverse outcomes (hazard ratio: 0.75; 95% confidence interval [CI], 0.64 to 0.89; P<0.001) over the standard treatment options, although they generally showed increased risks of side effects from hypertension medications including orthostatic hypotension, syncope, and bradycardia.  The trial was stopped short of its goal at a median of 3.26 years due to the clear protective effects of the intensive care study.

This study is important to our profession, because as pharmacists we may see the standards of hypertension care change to reflect better patient outcomes.  The result would be increased concurrent blood pressure medications to reach lower blood pressure goals than under previous guidelines.  The increased potential for drug-drug interactions and adverse effects from different classes of medications will increase the necessity of appropriate MTM techniques.  The question that was raised by the study is an important consideration before treatment guidelines should be changed.  Is the potential for fewer adverse outcomes of hypertension via intensive treatments worth the increased risk of drug interactions and adverse side effects from more prescriptions?  What do you think?

The SPRINT Research Group. A Randomized Trial of Intensive Versus Standard Blood-Pressure Control. N Engl J Med. 2015;373:2103-16. DOI: 10.1056/NEJMoa1511939 (Published November 26, 2015)

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1511939