Utilising digital health to improve medication-related quality of care for hypertensive patients: An integrative literature review

Table 3 Comparison of findings between digital health interventions

DHI	Key findings (impact of DHI)
	Perception about devise use		Clinical assessment and care	Practice and self-management
mPower Heart[23]	73% of physician agreed with the mDSS suggestion		SBP of the intervention group was reduced by 14.6 mmHg from the baseline. Detected newly hypertension 3152 cases (52%)	Empowered nurse for management of hypertension, promoted evidence-based practices and overcoming the clinical inertia
NR (Mobile)[39,45]	The application was used 10305 times and encouraged participants to change health behaviours		Reduction in BP for the intervention group was 2.7 mmHg from the baseline but was not significance. No significant differences in health care resource utilization	Significant differences in health self- management and health behaviour change but no difference in medication adherence between groups
HINTS[27,31,42,44,47]	Most of the participants reported that the HINTS was useful		SBP of the intervention group was reduced by 6.5 mmHg from the baseline. Significant reduction in SBP for combined intervention group at 12 mo but not significant difference at 18 mo	Patients receiving medication management achieved a clinically significant reduction in SBP relative to those not receiving medication management
DMO[43,49]	Participants with lower adherence benefited more from seeing the reminder messages		SBP of the intervention group was reduced significantly by 9.0 mmHg from the baseline. The intervention group had a greater proportion of meeting goal compared with usual care group	Medication dose reminders were associated with the improving medication adherence, especially in lower adherence group. Mean medication adherence was 86% and mean on-time adherence was 69.7%
	Perception of DHI	Clinical assessment and care		Practice and self-management
DTxs[25,26]	Cost effectiveness at total 3-year program	Significant reduction of SBP was 11.5 mmHg and 17.6 mmHg for stage 2 hypertensive participants		Substantial cost savings by reducing the use of conventional medications
eHSM[24]	NR	SBP of the intervention group was reduced by 11.4 mmHg from the baseline which was greater than the control group		The intervention group showed significantly greater improvement in self-efficacy and self-care behaviour than the control group at 24 wk post-intervention
mHealth[46]	NR			Participants who completed 4 or more phone calls did not had a statistically significant decrease in SBP compared to those who completed fewer calls
CPS[28]	NR	A mean SBP reduction was 26.00 mm Hg		84% of hypertensive participants were discharged after achieving their goal and tobacco cessation was achieved in 42% of targeted patients
NR (Internet)[40]	NR	SBP of the intervention group was reduced by 7.5 mmHg from the baseline but was not significant		The expert-driven group was more effective than the control group
SMASK[22]	NR	SBP of the intervention group was reduced by 9.6 mmHg from the baseline		Establishing and sustaining control of SBP was greater in the intervention group than the control group (11%)
	Perception of DHI	Clinical assessment and care		Practice and self-management
Ochsner[48]	NR	Reduction in BP for the intervention group was 14.0 mmHg from the baseline and 71% of intervention group met target blood pressure control		Mean patient activation was increased by 2.2%. The proportion of patients with low patient activation decreased by 9% and excess sodium consumption was decreased by 24% in the intervention group
DHFS[29]	Participants had positive experience and found the DHFS was helpful	SBP of the intervention group was reduced by 7.9 mmHg from the baseline		Participated pharmacists found the program helped in targeting specific recommendations and creating a collaborative experience with their patients
REACH[50]	NR	SBP of the intervention group was reduced by 10.1 mmHg from the baseline		NR
Pill Phone[51]	Majority of participants (96%) reported a high level of satisfaction	SBP of the intervention group was reduced significantly by 9.0 mmHg from the baseline		92% of participants were engaged in the pre- and post-Morisky medication adherence intervention
NR (SMS)[52]	The intervention group had a positive response toward the SMS service	SBP of the intervention group was reduced by 8.0 mmHg from the baseline		The regular reminders were found very useful in enhancing medication adherence, and educational SMS improved adherence to use of medicines on time
	Perception of DHI	Clinical assessment and care		Practice and self-management
eSahha[32,54]	94% of participants perceived the SMSs as useful and easy to read and understand	SBP of the intervention group was reduced significantly by 1.9 mmHg from the baseline. The refugee camps group had a significantly higher response rate than those in rural areas group		76.9% of participants using SMS through behavioural modifications to improve medication adherence. The appointment showup was associated with knowledge of referral reasons and the employment status
mWellcare[41]	68% of doctors accepted decision support recommendation for hypertension	SBP of the intervention group was reduced by 15.9 mmHg from the baseline but was not significant		The intervention group reported significantly greater adherence to medication more than the control group, but no significant difference in changes for tobacco and alcohol use
DREAM‐GLOBAL[30]	NR	SBP of the intervention group was reduced by 5.3 mmHg from the baseline but was not significant. The success in BP control was 37.5% in active group and 32.8% in the passive group		Within the first 2 mo of follow-up, 9 of the participants were able to consistently control the blood pressure
MESMI[55]	All participants reported satisfaction with the intervention	SBP of the intervention group was reduced by 6.9 mmHg from the baseline but was not significant		No difference in medication adherence between groups. Participants enjoyed being more actively engaged in their self-management

DHI: Digital health intervention; NR: Not report; BP: Blood pressure; SBP: Systolic blood pressure; HINTS: Hypertension Intervention Nurse Telemedicine Study; CPS: Clinical pharmacy specialists; DMO: Digital medicine offering; eHSM: eHealth self-management; SMASK: Smartphone Medication Adherence Saves Kidneys; DHFS: Digital health feedback system; SMS: Short Message Service; DTxs: Digital therapeutics; MESMI: Medication Self-Management Interventio.