Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2020; 8(11): 2266-2279
Published online Jun 6, 2020. doi: 10.12998/wjcc.v8.i11.2266
Utilising digital health to improve medication-related quality of care for hypertensive patients: An integrative literature review
Kannikar Wechkunanukul, Daya Ram Parajuli, Mohammad Hamiduzzaman
Kannikar Wechkunanukul, College of Nursing and Health Sciences, Flinders University, Bedford Park 5042, Australia
Daya Ram Parajuli, Mohammad Hamiduzzaman, Flinders University Rural Health SA, College of Medicine and Public Health, Flinders University, Renmark 5341, Australia
Author contributions: Wechkunanukul K performed review, data extraction and data synthesis and wrote the paper; Parajuli DR performed article review, data extraction and reviewed final draft paper; Hamiduzzaman M performed data extraction and reviewed the final draft paper.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kannikar Wechkunanukul, BPharm, PhD, Academic Research, Lecturer, Pharmacist, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park 5042, Australia. kannikar.w@flinders.edu.au
Received: January 15, 2020
Peer-review started: January 15, 2020
First decision: February 26, 2020
Revised: April 1, 2020
Accepted: May 27, 2020
Article in press: May 27, 2020
Published online: June 6, 2020
Processing time: 145 Days and 0.8 Hours
Abstract
BACKGROUND

Hypertension or high blood pressure is considered as a significant contributor and risk factor to many serious conditions, approximately 1.13 billion people have hypertension globally. However, the integrated technologies can upscale health provisions and improve the effectiveness of the healthcare system. WHO has recommended that the digital health interventions (DHIs) and the Health System Challenges should be used in tandem in addressing health.

AIM

To summarise the outcomes from a range of research which investigated the use of DHI to improve the medication-related quality of care (MRQOC) for hypertensive patients.

METHODS

An integrative literature review was undertaken in October 2019 using the Medline, Cumulative Index of Nursing and Allied Health Literature, and Scopus databases for publications in English with no date limit.

RESULTS

In total, 18433 participants were included in this review from 28 studies meeting the eligibility criteria. There were 19 DHI identified within eight countries: Australia, Canada, India, South Korea, Lebanon, Pakistan, the United Kingdom, and the United States of America. The DHI were provided as community-based, clinical-based and home-based program through mobile phone, mobile health system, short message service, and telehealth, digital medicine, and online healthcare (web-based). The mean age of participants was 59 ranging from 42 to 81 years with an average mean systolic blood pressure of 143.3 mmHg at baseline, ranging from 129.0 mmHg to 159.0 mmHg. The proportion of male participants ranged from 13.9% to 92.0%. Eighteen interventions showed evidence of reduction in blood pressure and improvement of self-management in relation to medication adherence and blood pressure control. The reduction of systolic blood pressure ranged between 1.9 mmHg and 26.0 mmHg, with a mean of 10.8 mmHg. The digital health was found positively associated with the MRQOC for hypertensive patients such as improvement in medication adherence and medication management; better blood pressure control; maintaining follow-ups appointment and self-management; increasing access to healthcare particularly among patients living in rural area; and reducing adverse events. However, some interventions found no significant effect on hypertensive care. The follow up duration varied between 2 mo and 18 mo with an average attrition rate of 10.1%, ranging from 0.0% to 17.4%.

CONCLUSION

Utilising digital health innovation for hypertensive care in different settings with tailored interventions positively impacted on MRQOC leading to an improvement of patient outcomes and their quality of life. Nevertheless, inconclusive findings were found in some interventions, and inconsistent outcomes between DHI were noted. A future research and evidence-based DHI for hypertension or chronic diseases should be developed through the evidence-to-decision framework and guidelines.

Keywords: Hypertension; Digital health; eHealth; mHealth; Medication-related quality of care

Core tip: The soaring prevalence of hypertension imposes a tremendous public health burden globally. In 2015, more than a billion people were diagnosed with hypertension, but only 1 in 5 of them can maintain their optimal blood pressure. The evidence showed the effectiveness of medication management models performed by multidisciplinary healthcare teams significantly improve the medication-related quality of care (MRQOC) such as medication appropriateness and health care accessibility. Digital health interventions have been implemented widely into the diverse healthcare systems to improve health provisions and outcomes. This article reveals the summaries of digital health innovations used to improve MRQOC for hypertensive patients, the intervention outcomes, perception of using digital tools and challenges of implementing digital innovation into practice.